Hold Her Hand Programmes
Medical
Educational
Social
Cultural
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The nature of sponsorship funding means we can commit to making these long-term changes in their lives, not just quick fixes. We can plan for their future and give them stability, health, education and recognition.
This programme is open to:
Individuals Groups Schools or individual classes within a school Organisations & Businesses You will receive information of how your sponsorship made an impact in the life of a children, these will be emailed updates including photos and videos.
Sponsorship Form
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Outreach Moldova is an Irish registered Charity set up in 2000 to bring both medical and humanitarian assistance to severely disabled, orphaned and abandoned children in the Republic of Moldova. When you sponsor a programme with ORM you can help provide hope for these children with disability, terminal illness and often their whole communities. You as a sponsor get a chance to stand up for the rights of a child in need. Your sponsorship will go towards education, medical and social care. Where possible it will go towards sponsoring a reintegration of the child back into their biological or extended family as part of our social care programme. Your engagement and participation in our Child Sponsorship Programme will make a huge difference to the daily lives of the children in the care of ORM. Our commitment to the children and the life changing development programmes is dependent on your generosity. Thank you for taking the time to complete the sponsorship form with a generosity of spirit that will ensure the long term viability of these programmes.
I want to sponsor: Medical Physiotherapy Speech Therapy Dentistry
School Music/Dance/Sport Arts & Crafts Dressmaking
by making a monthly/yearly donation of €5 €10 €15 €20
€25 €50 other
Would you like to receive updates on your sponsored programme?
Yes
No
Payment Options (please circle one option)
1) Standing order monthly/annual: please complete the form below for the bank and return to us to the address: Suite 104, DMG House, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland 2) Credit card (online in our website: www.outreachmoldova.org click on “make a donation” and complete the form quoting “ HHH”in a reference field 3) Cheque payment, payable to Outreach Moldova. Return the cheque with this form completed with your details.
Request for Standing Order
To: The Manager __________________________________________________________ Bank Name: ______________________________________________________________ Bank Address: ____________________________________________________________ You are authorised to set up a standing order on my/our account as specified below. My/our account will at all times contain sufficient funds to enable each payment to be effected on the due date. My name: _______________________________________________________________ My address: ______________________________________________________________ My email: _______________________________________________________________ My contact Tel: ____________________________________________________________
Please charge my account:
per month
per year
Payment amount: ___________ A/C number: _____________________________ Sort code: _______________________________ Name of Account: __________________________ Commencing with first payment on (dd/mm/yyyy): _________ Signature: _____________________________________ Date: ________________________________________ Ref: HHH _____________________________________ (to be completed by Outreach Moldova)
And Pay To:
Name of Account: Bank: Branch: NSC: A/C Number:
OUTREACH MOLDOVA BANK OF IRELAND TRINITY 90 00 17 95 48 90 71
Suite 104, DMG House, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland Tel/Fax: 01-219 0268 Email: info@outrechmoldova.org Web: www.outreachmoldova.org Charity Number: 20045838 Address: