Yes, I want to sponsor the Ibn Rushd Fund
Please print this form, fill it out, and send it to
the
following address by mail or by Fax:
Ibn Rushd e.V., Wiesenstr.53, Schoenwalde,
Germany, Fax: ++49- (0)33056 43 64 70
| Name: | ________________________ | Title: | ________________________
________________________ |
|
| First Name: | ________________________ | Occupation | ||
| Street: | _________________________________ | |||
| City: | ________________________ | Zip Code: | ________________________ | |
| Country: | __________________________ | |||
| Phone #: | ________________________ | Fax #: | ________________________ | |
| E-Mail: | __________________________________ | |||
| Date of Birth (voluntary): __________________________________ | ||||
| I agree that my name will be shown on the IBN-RUSHD web site as a donor: | Yes_______
No________ |
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| The recommended annual contribution is EUR 50,-- | ||||
| Date: | ______________ | Signature: | ____________________________ | |
If you wish to become an active member, please contact us.
Thank you for your support. You are thus making an important contribution to freedom and democracy in the Arab World. Sponsor donations can be transferred to:
Ibn Rushd regd., Bank Account # 704 128 600, Volksbank Brilon, Bank Code #41 661 719, Germany.