ILA 2010 - Sponsorship Form

(* = these fields are mandatory)

Name KKI Ministry Affiliation:
Address:
E-mail Address: *
Phone #:
Fax #:

The total amount I am able to contribute (please list amount in US Dollars): I would like to give  toward the expenses of  from

I will send my gift in the form of a US Dollars check before the 12. January 2010 cut off date.	yes no
I will bring my gift with me to the ILA in March.	yes no
I will deposit my gift into the bank account of KKI Brazil.	yes no

 Bank Transfer Information:

Name & address of account owner:	JOCUM - Jovens Com Uma Missao Pitangui, Avenida Evaristo Miranda de Araujo, 219 Brumado Pitangui-MG Brazil 35650000
Name & address of bank:	Bradesco; Praça da Camara 27 Centro Pitangui-MG Brazil 35650000 (Branch number: 1862-7)
Bank Identifier Code (BIC) or SWIFT:	BBDEBRSPBHE
Account No.:	C/C 8111-6