Swimathon

and the team:
and the swimmer:

* Name and first name:
Society / institution:
* Phone number:
* E-mail:
Address:
City:
Within Swimathon organized by Community Foundation Mures
with the amount of: 1 LEI 3 LEI 5 LEI other amount for every / lenght swimmed within the 60 minutes of the competition
------------------------ OR ------------------------
the exact amount of :
I want my support to be public to be kept confidential
Payment options Cash payment Online by credit card by bank transfer
Banking data: Fundația Comunitară Mureș, CUI: 29420428, Cont bancar: RO 78 BTRL 0270 1205 J646 58XX, Banca Transilvania Tg. Mures, 540089 - Tîrgu-Mureș, str. Avram Iancu nr. 37
Payment order mention "Contribution for Swimathon for team/project name "
http://swimathon.ms
Form validation will be done through the link sent by email at the address indicated above.
Other information: swimathon@fcmures.org
Contact details are kept strictly for internal use of Community Foundation Mures and will not be passed to third parties.