Donation Request
Donation Request
WHMC (Women’s Health Mobile Clinic)
Rotary Club Bali Taman D3400, Indonesia
Your donation will be used to further the health condition of Balinese women who do not have access to health information nor health care.
Name
Address
City
State/ Region
Country
Phone
Email
My donation is (USDollars only. Please tick your choise):
US $ 50
US $ 100
Your comments (max. 200 words):
T
HANK
Y
OU
R
OTARY
C
LUB
B
ALI
T
AMAN
