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Pledge / Donation Form

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Education Program
Company or Individual Name
Contact Name (For Company only) :
Address :
City :
Province :
Postal Code :
Email :
TEL :
Day Time:
Designated For : (Please check one)
1. Guangxi
  • Teacher
  • : 1 Year CAD$ 200 
  • 3 Years CAD$ 600 
  • Student
  • : 1 Year CAD$ 180 
  • 3 Years CAD$ 540 
  • University
  • : 1 Year CAD$ 700 
  • 4 Year CAD$ 2800 
2. Shanghai
Migrant Student : 1 Year CAD$ 500            2 Years CAD$1000
3. General Fund    :
4. Education Fund :
5. Benevolence     :
I would like to make a one time donation of $
Donation Receipt : (Please tick one)
Sent after every transaction
Send after the year end
Payment by PayPal        Payment by Credit Card

Payment Method
• A cheque is enclosed (payable to CRRS (Worldwide) Foundation)
• Please charge the above to my credit card (Visa or Master Card)
Card Number:
Exp. Date:
Name on the card:
Authorized Signature: