DONATION FORM

I’m helping Kalaweit by making a donation.

Name :_________________________________________________________________________

Firstname :______________________________________________________________________ Adress :_________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Phone :__________________________________________________________________________ Mobile Phone :____________________________________________________________________ E-mail :_________________________________________________________________________ Amount : _________ $ City Date Sign Kalaweit : 69 rue Mouffetard – 75005 Paris Email : kalaweit.france@yahoo.fr / tél : 07 86 01 18 87 Site internet : www.kalaweit.org SIRET : 449 804 053 00030