Pledge Form

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Donation Form

Are you representing a:(Required)

Name(Required)

First Last

Name of org. if Legal Entity:

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I wish to make a pledge in:(Required)

USD

EUR

The amount of:(Required)

Please enter a number greater than or equal to 5.

I wish my donation support this area:

I would like to dedicate this donation as follows:

Name

Bank account name: OJQ STEM
Bank/Financial Institution: NLB BANKA
Account number: 1708017700032087
IBAN: XK051708017700032087 SWIFT: NLPR XK PR

You may attach the confirmation document here(Required)

Accepted file types: pdf, Max. file size: 64 MB.

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