Authorization form

Children have the right to be children. to dream and to play. That is why I have chosen to become a friend of the International Business for Children Foundation: Name: Initials: Surname: Street: Number: Postal code: Place: Country: Select CountryUnited States AfghanistanAlbania AlgeriaAmerican Samoa AndorraAngola AnguillaAntarctica AntiguaArgentina ArmeniaAruba AustraliaAustria AzerbaijanBahamas BahrainBangladesh BarbadosBelarus BelgiumBelize BeninBermuda BhutanBolivia Bosnia and HerzegovinaBotswana BrazilBritish Virgin IslandsBrunei BulgariaBurkina Faso BurmaBurundi CambodiaCameroon CanadaCape Verde Central African RepublicChad ChileChina ColombiaComoros CongoCook Islands Costa RicaCote d'Ivoire CroatiaCuba CyprusCzech Republic DenmarkDjibouti DominicaDominican Republic EcuadorEgypt El SalvadorEquatorial Guinea EritreaEstonia EthiopiaFalkland Islands Federated States of MicronesiaFiji FinlandFrance French GuianaFrench Polynesia GabonGaza Strip and West BankGeorgia GermanyGhana GibraltarGreece GreenlandGrenada GuadeloupeGuam GuatemalaGuinea Guinea-BissauGuyana HaitiHonduras Hong KongHungary IcelandIndia IndonesiaIran IraqIreland IsraelItaly Ivory CoastJamaica JapanJordan KazakhstanKenya KiribatiKorea KuwaitKyrgyzstan LaosLatvia LebanonLesotho LiberiaLibya LiechtensteinLithuania LuxembourgMacau MacedoniaMadagascar MalawiMalaysia MaldivesMali MaltaMarshall Islands MartiniqueMauritania MauritiusMayotte MexicoMoldova MonacoMongolia MontserratMorocco MozambiqueNamibia NauruNepal NetherlandsNetherlands AntillesNew Caledonia New ZealandNicaragua NigerNigeria North KoreaNorthern Mariana IslandsNorway OmanPakistan PalauPanama Papua New GuineaParaguay PeruPhilippines Pitcairn IslandsPoland PortugalPuerto Rico QatarReunion RomaniaRussia RwandaSaint Kitts and NevisSaint Lucia Saint Pierre and Miquelon Saint Vincent and the GrenadinesSamoa San MarinoSao Tome and PrincipeSaudi Arabia ScandinaviaSenegal Serbia and MontenegroSeychelles Sierra LeoneSingapore SlovakiaSlovenia Solomon IslandsSomalia South AfricaSouth Korea SpainSri Lanka SudanSuriname SwazilandSweden SwitzerlandSyria TaiwanTajikistan TanzaniaThailand The GambiaThe Holy See TogoTonga Trinidad and TobagoTunisia TurkeyTurkmenistan Turks and Caicos IslandsTuvalu UgandaUkraine United Arab EmiratesUnited KingdomUnited States Virgin IslandsUruguay UzbekistanVanuatu VenezuelaVietnam West Bank and Gaza StripWestern SaharaYemen YugoslaviaZaire ZambiaZimbabwe Email: Telephone: Sex: Man Women Birth of date: --(dd-mm-yyyy) Amount: (in euro's min. 4 euro) Period: monthly yearly one-time donationn Bank number: Bank Giro Authorization:: With the sending of this form, I herewith give permission to International Business for Children Foundation to deduct the given amount from my banking account.  I will receive a confirmation for this authorization by E-mail.      You may also print this form out sign it and send it to us: Stichting International Business for Children van Anrooijstraat 27 5343BA Oss The Netherlands Chamber of Commerce: 17181937   Thank you for your support