Surname:
First name:
Address:
Date of birth:
Telephone:
Email:
Montly donation to help a child:	60 Ron
Another amount:
Means of payment you prefer:	Plata programata Virament bancar lunar Virament bancar trimestrial Mandat postal Plata directa la sediul FRCCF
Other means:
Would you like to be reminded to make the payment:	Da Nu
If yes, how?:	E-mail Telefon
Would like to receive letters from the child?:	Da Nu
Other suggestions or options?: