Earth Rights Institute
JATUKIK ECO-VILLAGE INITIATIVE
Democratic Republic of Congo

Thank you for your active support of the Jatukik Eco Village Initiative.

Name:
Organization:
Organizational Role:
Street Address / Box #:
City:
State/Province:
Postal Code:
Country:
Phone:
Fax:
Email:
Website:

Please check the boxes below to indicate your Partnership Commitments:

Include me on the ERI DRC e-list to receive approximately two updates per month.

You may list me as an endorser of the Initiative.

You may list my organization as an endorser of the Initiative.

I / my organization is willing to partner with the ERI DRC in these capacities:

I / my organization hereby volunteers these services:

I / my organization will give and be listed as a contributor.
N18,000 / $150 / # 100 / Euros 180

I/my organization will give and be listed as a supporter.
N60,000 / $500 / # 400 / Euros 600

Financial contributions should be marked for DRC and made payable to:

Earth Rights Institute,
Box 328, Scotland, PA 17254 USA (Tax deductible.)
Tel: 301 439-1880 Email: annie@earthrights.net

If you receive this form by email, please email to both of us your intent to contribute financially and when and how we should expect to receive your contribution. We are maintaining clear, audited and transparent financial records available at your request. Thank you very much.

Annie Goeke annie@earthrights.net

Fr. Jean Claude Atusameso jatusameso@earthrights.net

Return to Democratic Republic of Congo Initiative
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Last modified: 29 September 2004

http://www.earthrights.net/congo/appform.html