Global Citizen Programme 2015 Payment Form

Please double check whether the deposited account and amount are correct. You should have deposited $1,875 to 178-790929-838 at HSBC. Please hand in the physical receipt during the contract-signing session in the Global Citizen Mini-Conference. Thank you.

First Name (e.g. Tai Man) *

Last Name (e.g. Chan) *

English Name *

UID *

Academic Programme (e.g. BA II) *

Mobile Phone Number *

Which sub-product do you belong to? (Please refer to the email) *

Are you an AIESECer? *

If Yes, which department in AIESEC are you from?

Email Address *

Your Account Number *

Your Bank *

Bank-in Date *

(Use YYYY-MM-DD for date and HH:MM:SS for time)

Date

Time

Bank-in Receipt *

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