Batey Relief Alliance Online Application

 

Join the BRA team in becoming a Sponsor, Member or Donor

 

 

Name:

 

Address:

 

Phone:

 

Title/Business/Organization:

 

 

 

Business Address:

 

 

 

Business Phone:

 

 

Fax:

 

 

e-mail:

 

Yes, I want to to be involved with BRA:

Please accept my general donation of:

$50 annually for Membership. $250 annually for Child Sponsorship.

Yes I want to become a Financial Sponsor.

Please accept my contribution of:

$1,000.00. $3,000.00 $5,000.00.

Other Amount:

Please make Cheques or Money Orders Payable to Batey Relief Alliance

 

Yes I want to become a medical volunteer. I am a doctor. I am a nurse.

Other Occupation:

 

Yes I want to become a donor of equipment. Medical. Canteen. School. Office.

 

Other Equipment:

 

 

I want to be involved with: Please highlight applicable areas.

Press Command (Open Apple) on Macs and Control on PC's to make more than one selection.

 

This form may also be printed out and returned with a cheque or money order mailed to:

Batey Relief Alliance, Inc.

P.O. Box 300565

Brooklyn, NY 11230-0565

 

For more information, please call: (718)434-6388 or e-mail: sosbatey@aol.com

 

If you are in the Dominican Republic, please contact:

Batey Relief Alliance, Inc.

Maria Virtudes Berroa, Directora

Apartado Postal 5085

Santo Domingo, Republica Dominicana

 

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