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Child Sponsorship Form
Child Information
Reference Number:*
Name of Child:*
Village/House*
Date of Birth:* 
E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Billing Information
First Name:*Same name as on your card
Middle Initial:
Last Name:*
Address Line 1:*Where your statement is mailed
Address Line 2:Apt. or Suite No.
City:*
State:*
Zip Code:*
Phone:*
Sponsorship Information
Sponsor a Child:  Monthly $25.00  
Sponsor a Child:  Annually $300.00  
Sub-Total:
Additional Donation:
Grand Total:
Credit/Debit Card Information
Card Number:*No dashes or spaces please
Expiration Month:*From your card
Expiration Year:*From your card
Card Brand:*
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