Donate

Use this form to donate to our organization without becoming a member.

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Name and Contact Information

First Name: *

Last Name: *

Country of Residence: *

Phone: *

Email Address:

Donation Type

I would like to contribute the following amount: *

Please specify the currency if you will not be donating in US dollars.

How often would you like to make your donation?: *

Once

Annually

Would you like to contribute a used Laptop to help bridge the gap in Technology?:

Yes

Please specify the laptop model,condition and any additional information in the comment section below.

Can we display your name on our Donors List?: *

Yes

We will only display your name, no other personal information will be made publicly available about you.

Comment:

Enter any additional information or questions you would like included with your donation here.

CAPTCHA

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Math Question: * 2 + 2 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Korem & Surrounding Communities Development Organization