Donation Form PDF Print E-mail
Written by Dom Derrien   
Tuesday, 22 April 2008 13:46

Please print the simpiflied version of this page using "CAPITAL LETTERS", and send it to Yvon Dupuis as proposed.


Your Information

First name, Last name: __________________________________________
Address: __________________________________________
__________________________________________
__________________________________________
City: __________________________________________
Postal Code: ____  ____
Home Phone Number: (____) ____  ______  ______
Business/Cell/Alternate Number: (____) ____  ______  ______
E-mail: __________________________________________


Action

I WISH TO MAKE A DONATION FOR THE FOLLOWING AMOUNT $_________. I will send my donation by Cheque or Mailing Order to:

Diku Dilenga,
c/o Yvon Dupuis
137 Mont Bleu bvd
Gatineau (Qc) J8Z 1K2

I WOULD LIKE MY DONATION TO GO TOWARDS (please circle your selection):

  • Supporting the general Diku Dilenga project budget, with a view to fund priority areas, respecting the needs and wishes of the people of the Democratic Republic of Congo.
  • Supporting one of the following projects1:
    • Penpal programme (pairing students in Canada and the Democratic Republic of Congo, providing stamps, letter writing materials, etc.)
    • Providing school materials (notebooks, pencils, chalk, textbooks, etc.)
    • Sending needed medical supplies (general medicine, dentistry, etc.)
    • Financing microcredit loans

I UNDERSTAND THAT THE RECEIPT PROVIDED for my donation is not tax deductible. Diku Dilenga Canada is not yet recognised as a registered charity. We are, however, in the process of registering the organization. THANK YOU for your generosity.

I WISH TO VOLUNTEER AND HELP Diku Dilenga Canada increase support for Microcredit. Please contact me to discuss how this can be achieved.

ALONG WITH A RECEIPT FOR MY DONATION, I wish to receive additional information about the following Diku Dilenga Project (see list above): _________________________________________________



Signature

Signed at: ___________________________
Date: ___ /___ /_____







Note 1: Projects listed here are the one Diku Dilenga can easily communicate about on its webite http://diku-dilenga.org. Check the website for an up-to-date project list.

Last Updated on Thursday, 01 May 2008 01:38