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Become a contributor

Application for Regular Contributor

To the Chairman,

I would like to contribute regularly/event-wise to the activities of HEADS Nepal and express my commitment.

Name

Sex

Current Address

Province

District

Palika

Ward Number

Tole

Contact Address

Email Address

Phone Number

I would to like to contribute for:

Amount to contribute in Rs.

Scholarship for needy student -> We provide Rs.5,000-10,000 per year per student.
Medical expenses -> We provide Rs.5,000-10,000 per patient according to their need.
Blood donation -> We estimate Rs. 20,000 for a camp.
Medical camp -> We estimate Rs. 3,00,000 for one day camp.