For an individual, in France, up to 66% and within the limit of 20% of his / her taxable income. For an enterprise, the deduction is within the limit of 0.225% of its gross revenue.

A certificate of donation will be sent to you upon reception of your cheque.

The Association appreciates your generosity and is committed to utilise your donations rightfully.

Yes! I wish to help the association...

And am sending to you a cheque addressed to:

A.M.P.H.O.R.E. INTERNATIONAL

Service O.R.L., Hôpital Clavary - 06130 GRASSE France

Name:...........................................Initial:.......................First name:..........................

I know your association through:.............................................................................

Address:............................................................................................................................................................................................................................................................Zip code:.....................City:......................cOUNTRY/.....................

Telephone: Office:.........................Home:..............................Mobile:.......................

I wish to become a member:

_ "Regular": - I pay my membership fee of 20 Euros

_ " Benefactor": - I make a donation of:

30 Euros, 50 Euros, 100 Euros, other amount:

_ "Active": I wish to participate to the preparation in France of next mission,

_ " Medical care" : I wish to participate to the next mission with the following

medical competence:...........................................................

_ I wish to be kept informed on the activities of the association.

Amount of the cheque:.........................Bank:.................................N°:....................................

Date and signature: