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Registration Form for donations made by Cheque/DD/Pay Order or Credit/Debit Card
Please fill in the form below to send in your donation.
Fields marked * are mandatory.
  Your Name *
  Organization Name
  Address *
 State *
 City *
 Postal Code *
  Phone *
  Mobile
  e-mail *
   
Please accept my donation of   Rs.
Purpose of Donation
Permanent Account Number (PAN) *

Mode of Payment: 
Cheque / Pay Order / DD - To be sent by courier/post to

INDIAN CANCER SOCIETY
74, Jerbai Wadia Road,
Bhoiwada, Parel,
Mumbai - 400012.
Tel: 91-22-24139445 / 51
email: info@indiancancersociety.org
 
Payment via Credit / Debit Card

2.5% deduction will be made for bank/credit card company charges

Please note that online donations at present cannot be accepted from foreign nationals/organisations. Likewise, credit/debit cards issued outside India are not accepted for online donations.
I have read the Terms and Conditions and hereby agree to the same.
 

   

 

OR
 
Donations made by HDFC Bank Customers
HDFC Bank customers can donate on-line using their NetBanking account by clicking here