DONOR REGISTRATION FORM

DONOR REGISTRATION FORM

Fields Marked with '*' are Mandatory.
Full Name as in Passport*

First NameLast Name
I would like to donate*
E-mail ID*
Citizenship *
Full Address as per records*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Scanned Copy of your Indian Passport*

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I declare that I am an Indian citizen, above 18 years of age and am making this contribution voluntarily from legally earned personal funds. I also permit The Ministro Foundation to communicate with me using my phone and/or email specified above. The particulars and statements made above are correct to the best of my knowledge and nothing has been concealed or withheld.
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