BINA ROY PARTNERS IN DEVELOPMENT
FINANCIAL CONTRIBUTION FORM

Fields marked * are required.

FULL NAME of national federation / association / branch / individual wishing to make a donation *:

ADDRESS *:
(to be used for sending you news and information about BRPID projects)

STREET*:
CITY*:
STATE:		POSTAL CODE:
COUNTRY*:
E-MAIL*:

AMOUNT OF CONTRIBUTION*:
(please state currency)

COMMENTS:

PAYMENT DETAILS*:

	Bank transfer to IFUW (account details will be provided after you submit this form)
	Paypal (Paypal payment link will be provided after you submit this form)
	Check (for donors in the USA only) Donors in the USA may send their check donations directly to IFUW Assistant Treasurer: Karen McKee 168 Western Gailes Williamsburg, VA  23188 USA Please include your name, state and branch and indicate it is a BRPID donation.

Signed*:

Date*:

 

If you have problems sending the application form, you may print a copy and fax it to IFUW Headquarters - Fax: (+41 22) 738 04 40.