I would like to make a donation of US $___________________ written out : ________________________________________ Donation :    one-time      monthly           Please debit my credit card ____ Discover ____ Visa ___ MC Credit card Number ________________________________ Expiration Date _____ _____ _____ With my signature below, I authorize the National Heritage Foundation (NHF) to process this donation on behalf of YKIP, Foundation No 1138228. I understand that my billing statement will show a charge form the NHF. This form may be faxed/sent to either YKIP (Jalan Kediri No. 38, Kuta, Bali, Indonesia, fax + 62 361 755024) or to The National Heritage Foundation, 6201 Leesburg Pike, Suite 405; Falls Church, VA 22044, fax + 1 (703) 820-5100 Please inform YKIP (info@ykip.org) of your donation amount with the date sent and your name. Thank you very much for your support. YKIP is a National Heritage Foundation, a 501 (c)(3) non-profit charity. TIN 58-2085326 www.nhf.org All donations are tax-deductible for US taxpayers. ________________________________ Signature Name ________________________________ E-mail ________________________________           Address _____________________________________________________ _____________________________________________________ I would like my donation to go to the following project/s: ___ Hearing Impairment Project ___ KEMBALI educational scholarships (please see details about funding HERE) ___ KIDS (children of the bomb victims' education) ___ MREC (Medical Research and Education Center) ___ YAKEBA Narcotics and AIDS/HIV Awareness in the Schools ___ North Bali Women's Health Care ___ YAKKUM Orthopedic Workshop ___ YRS Women's Reproductive Clinic ___ Wherever the need is the greatest