1、姓名：（如果你不愿意公开你的真实姓名，该处请忽略）

1、NAME: (Optional, but we suggest you fill out.)

2、化名：（你可以考虑公开一个化名）

2、Nickname: (You may consider publishing your alias.)

3、国家：3、NATIONALITY:

4、电子邮件：4、E-MAIL:

5、电话：5、PHONE:

6、我将参与2008年12月1日空腹24小时。（请在此处标记）

6、I will join the Twenty Four hour Hunger Strike action，on December 1,2008

YES OR NO?

7、我不参与2008年12月1日空腹24小时，但我愿意签名支持。

请确认你在“姓名”或者“化名”栏目至少填写一项。（请在此处标记）

7、I do not join the Twenty-four hour Hunger Strike action, but I am willing to sign my name to support .Please make sure that you have completed at least on of the “NAME” or ”Nickname” field above.

YES OR NO?

8、我为筹建“中国民间红丝带奖”捐赠。我将通过以下方式为筹建“中国民间红丝带奖”捐赠，请注意验收。

8、I am willing to donate for Setting up “China Non-governmental Red Ribbon Award”

我将捐赠 __________

I am willing to donate $_________

方法：

（1）您可以通过paypal的网上付费系统从您的Paypal帐户、信用卡（或者具有类似信用卡功能的银行帐户）捐款，我们的Paypal帐号是changkunchina@gmail.com ,请登录http://www.paypal.com

（2）国内汇款：

请首先于常坤联系。

（3）国际邮寄支票/汇票

票据抬头请写CHANG KUN如果捐款数额较大，请考虑使用快递邮寄方式，以防票据丢失。

CHANG，KUN

#134 ,5505 Montezuma Road,

San Diego CA 92115-2316

(1) You can use Paypal to make a contribution directly from your Paypal account or from your credit/debit card. Our Paypal account is changkunchina@gmail.com

The website is Http://www.HungerStrikeforAIDS.org/hungerstrike/donation.html

(2) If you would like to make a cash donation.

Please contact Chang Kun directly.

(3)International mail Check or Money order.

Notes payable to CHANG,KUN. For a large amount of contributions, consider using express mail in order to prevent losses.

CHANG，KUN

#134 ,5505 Montezuma ,

San Diego CA 92115-2316

如果你愿意以其他方式捐赠，请和我联系。

If you are willing to donate in some other way, please contact us.

9、注意事项：

（1）注意保重身体，量力而行；

（2）如有异常反应，请紧急联系医务人员；

（3）建议第一次空腹健身者，应有人伴随；

（4）参与自愿，行动自由，责任自负！

9、NOTICE:

(1)、The strike last only for one day; know your capabilities and only continue the strike as long as you think it is not endangering your health condition.
(2)、If you have any symptoms that are abnormal, contact emergency medical personnel immediately.
(3)、The first time you do a hunger strike make sure a friend or someone will always be nearby in case anything goes wrong.
(4)、Participation is of course voluntary; Participants have freedom of discontinuing the strike at any time. Participants are responsible of themselves.

10、联系Contact：

常坤 Chang Kun

Aidsrights.net@gmail.com

Http://www.HungerStrikeforAIDS.org http://www.aidsrihgts.net