Formulier - Noodhulp Malawi

First name*
Last name*
Address*
Postal code*
Town*
Email address*
Telephone*
What amount can Noodhulp Malawi collect one time only?*
*The minimum contribution is € 25,-. With this amount you can support a family for ten weeks.
What is your bank account number (IBAN)?*
Update Noodhulp Malawi
- I want to be informed of the latest news concerning Noodhulp Malawi.
Statement of agreement*
- I hereby declare to have filled in all information truthfully and authorise Stichting Raise to withdraw the mentioned amount from my bank account.