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Donating to project 15-2011-12: Batukuseni Medical Clinic, Bali, Indonesia

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Donating to project 15-2011-12: Batukuseni Medical Clinic, Bali, Indonesia

Your Details

Last Name or Organisation:

First Name (leave blank for organisations):

Are you a Rotarian/Rotaractor/Rotary Club?

Your Club:

Your District:

Address:

Town/Suburb:

State:

Postcode:

Country:

Email:

Confirm Email:

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	Note: Donation amount is in Australian dollars.
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Amount:
AUD

Note: Donation amount is in Australian dollars.

Note:

I would like to donate by:

Card Number:

Name on Card:

CVV:

Expiry Date:

Schedule:

Requests:

Donation Summary
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Rotarian:
Donation:
Method:
Schedule:

Thank you!


Project:
Donor:
Town/Suburb:
Email:
Rotarian:
Donation:
Method:
Schedule:

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Donating to project 15-2011-12: Batukuseni Medical Clinic, Bali, Indonesia

Your Details

Donating to project 15-2011-12: Batukuseni Medical Clinic, Bali, Indonesia

Your Details

Donation Summary

Thank you!