AAPEL
AAPEL's Donation Form
Association's statutes (in french)
Secure payment Euro Visa Mastercard / eurocard Check Bank Transfer Cash
(online secured payment by credit card or by mail)
Meme page en Francais / Same page in french
(Your are not required to fill all the fields)
I undersigned:
Ms. - Miss. - Mr. 
from the Company:
E-mail:(*)

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
City :
Country :
Phone number (home):
Phone number (office):
Fax:
Your questions, comments:
How did your heard about us ?
Enter the Code as you see in the right(*)
Please enter exactly this HumanVerify code as you see in the verify field below
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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Last update 2011
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Page created on november 27th 2OO2