Donation Form - Support a scientist in Siberia

Donation Form - Adopt a scientist in Siberia
  1. Donation Information
  2. Amount(*)

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  3. Other Amount
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    CHF
  4. Designation
  5. Type of gift


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  6. Corporate
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  7. Anonymous
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  8. Comments
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  9. Billing Information
  10. Title
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  11. First name(*)
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  12. Last name(*)
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  13. Country(*)
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  14. Address lines(*)
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  15. City(*)
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  16. State
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  17. ZIP(*)
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  18. Phone
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  19. E-mail(*)
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  20. Payment Information
  21. ReMedys Foundation
    Bank: Credit Suisse AG, Lausanne
    Account: 0425-1212288-91
    IBAN: CH16 0483 5121 2288 9100 0
    SWIFT-BIC: CRESCHZZ80A
    Clearing: 4835
  22. Matching Gifts
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  23. Tribute Information
  24. Type
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  25. Name
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  26.