Please, send me first a suggestion for a sponsorshop to my adress.
I will donate an amount of : EUR.
(The monthly minimum amount for a sponsorship is 30,00 EURO.)
House number and street::
Town/city and postal code::
I will pay this amount:
I will pay this amount by:
standing bank order
Edirect debit authorisation
(please send me the necessary forms)
or please print out this form and send it by post or fax to
Kardinal-von-Galen-Str. 19D-48712 Gescher
per Fax: +49 (0)2863 / 7193202