MEMBERSHIP FORM    
 Personal Data    Name and Surnames: (*)
Address:              
Business:                
Occupation :              (*)
 Sex   Male Female(*)
                Age: years(*)
 Contact Data    Phone:             home(*)
                             office
                             fax
Email:   (*)
 Preferred contact method   e-mail telephone(*)
 Donation  
 Amount of my donation  

US$10         US$25
US$50         US$200
 US$500       US$1,000
 Other amount: US$ (*)

  
 Payment method   

Credit card

Debit card
Cash
 Cheque
 Deposit(*)
 Volunteer Data

 Type of activity

None, I just want to donate
Stranding support
Administrative cooperation
Collaboration with Events organization
Support in research projects(*)

   
 (*) marked fields required.

IMPORTANT: If you are donating through credit or debit cards, come by our office to sign the release note.  If you are making a deposit, account number is 200-02-148-967-5 (dolar account), atl Banco Nacional de Costa Rica, registered to Fundación Promar, in which case we need the deposit voucher, to log it into our records.

 

 

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