Name:
Surname:
Date of Birth:
Blood Type:
Occupation:
Your School (If you are a student)
Adress:
Telephone:
E-mail:
What can you do for our foundation?
	I can help advertising I can make a donation I can sell your products I can help stand sales I can care for children I can take part in the organisations I can help in bureaucracy Others:
I accept all the principles of your foundation and I would like to work for LOSEV - Foundation of Children with Leukemia as a volunteer member.
Membership fee for one year is 16.000.000 TL for the year 2005.
I would like to pay with:	Money Order Credit Card
Payment with Credit Card:
Card Number:
Card Expiry Date:
*We need two photos for your ID card. *Do not hesitate to denounce people who work for LOSEV without an ID Card or who collect donations without giving receipt, to the local autorities. . * Your donation receipt will be sent to your adress as soon as possible.
THANK YOU!

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