The Cambodian Children's Fund / Phnom Penh, Cambodia

Fields in bold are required

- Step 1. Personal information -----

First Name:
Middle Initial:
Last Name:
Company:
Telephone:
Email:
Sex:	Male Female

- Step 2. Sponsor a CCF Child -----

Please choose:	Male Female Please choose for me
Preferred Age Range:	6-10 10-19 CCF Care Center Child Please choose for me
Request a Child:	Yes No
Child(ren)'s Name(s):
How Many Children would you like to Sponsor:

- Step 3. About your Sponsorship -----

Is this a Family or household sponsorship?	Yes No
If yes, with who?	My Spouse and I My partner and I My Family and I Other
How did you hear about CCF?	Friend Family Internet Co-worker Magazine Television/Cable Radio Other
Is there anything you would like to share with us about you and/or your family?

- Step 4. Address -----

Address:
Address 2:
City:
State/Province:
Zip/Postal code:
Country:

- Step 5. Online Payment Options -----

	Billing Address (If different)
Address:
Address 2:
City:
State/Province:
Zip/Postal code:
Country:
Type of Online Payment :	Visa Mastercard Amex
Name on Card:
Number:
CVV2 Number:	How do I find my CVV2 ?
Expiration Date:	Month Year
Amount and Interval:	$100.00 monthly for each sponsored child $1,200.00 yearly for each sponsored child
Number of children:
Total: $:

- Step 6. Submit Your Sponsorship -----

Cambodian Children's Fund is a U.S.-registered 501(c)3 not-for-profit organization no. 20-0764162. Donations are tax-deductible to the fullest extent of the law. The organization is also registered with the State of California and the Kingdom of Cambodia.