Single Donation Form - Print Version

Use my donation for:

Yushu Earthquake Emergency Relief

Yushu Re-build for the future

I enclose a cheque for £ _________ (please make cheques payable to: ROKPA)

Or please charge my CAF/Credit/Debit Card

Card Number: __ __ __ __ __ __ __ __ __ __ __ __

Valid From: __ __ Expiry Date: __ __ Security number: __ __ __

Signed __________________________________________ Date ___________

Mrs/Mr/Miss/Ms ___________________________________________________

Address _________________________________________________________

_________________________________________________________________

Post Code ________________ Email __________________________________

 

THANK YOU FOR YOUR SUPPORT!

Please return this form to: ROKPA UK Overseas Projects, Kagyu Samye Ling, Eskdalemuir, LANGHOLM, Dumfriesshire DG13 0QL Tel: 01387 373 232 Ext. 230

ROKPA UK is part of ROKPA Trust, reg. charity in England & Wales (1059293) and in Scotland (SCO38628)