Club1000 Signup
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Name:
Email:
Comment:
Email Address
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Title
First Name
Last Name
Phone Number
Sex
Female
Male
Age
18-25
26-35
36-45
46-55
Above 55
Birthday
Month
/
Day
Monthly Donation Amount
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1,000
2,000
5,000
10,000
20,000
Other/Annual
If other, please enter currency,amount & frequency
100,000 annually
Other Capacity you can give
Project Management Mentorship
Funding and Grants Advisory
Organisational Development Advisory
Business Communications
Media Engagement
Periodic/Long-term Volunteering (programs, IT, Education, Mentoring)
Material Donations (Books, Teaching & Learning aids)
