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"LET YOUR DONATIONS GIVE A CHANCE TO OUR CHILDREN WITH LEUKEMIA"
If you would like to contribute to the free treatment and education provided to children with leukemia, please fill the form below.

First Name
Please write the name of the donator.
Last Name
Please write the last name of the donator.
Donation Amount *     
(Please do not leave blank or use dot, dash and comma)
Type of Card
 
Credit Card Number *
(16 Digits)

  
 

(Be Sure That Your Credit Card Allows International Expenditure.)
Security Number *
 
(Last 3 digits of the number on the back of your credit card.)
Expiration Date * Month Year
 
 
 
Other Details
The details below are neccessary but not mandatory. Please provide the neccessary information to receive your receipt of donation, SMS text message and/or e-mail message.
Address
Country
City :
Phone
   
Mobile
   
ID Number
Please enter the ID Number of the Donator. Not mandatory
E-mail  
Required Information marked with * and written BOLD
 

(Please enter the letters in the box)