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Supporter/Volunteer Membership Form
Name & Family
Father
ID No
Study
Job
BirthDate
Tel
Address
participation honorarily
Finantial Team
Students Team
Medical Team
Cultural Team
Technical Team
Welfare & Assistance Team
Women Team
Donation (please specify the currency in front of the amount)
Monthly :
Rials
Annually :
Rials
Once :
Rials
As oblation :
Rials
Provide a property
Provide medical equipments
Afford expenses of a desired number of patients (please specify the number of patients and the desired amount of donation)
Any other help you can provide?