AAPEL - To give donation to the AAPEL

(online secured payment by credit card or by mail)

(Your are not required to fill all the fields)

I undersigned:

Ms. - Miss. - Mr.

from the Company:

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Please check otherwise we will not been able to contact you

Wish to make a donation to the AAPEL in position of (*)

Individual (personal) - Legal entity (company)

Amount of the donation:

.Euros or US$

I will pay my donation by:

(please select) - Credit Card (secured payment in next page) - Check payable to "AAPEL" - Bank transfer - Cash -Other

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Fax:

Your questions, comments:

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Enter the Code as you see in the right(*)

Thank you for your support

(France)

BAN - Bank Account Number

In accordance with the law "informatique and liberte" Jan 06th 1978, you have an access, modify and cancel right to your informations
Une fois la transaction effectuée, et afin de prévenir toute réclamation, anomalie, ou incident technique portant notamment sur le paiement sécurisé, l'adresse IP de l'ordinateur ayant servi est enregistrée lors de votre don.
Cette adresse ne donnera lieu à aucune utilisation commerciale de quelque nature que ce soit.

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