Name *
Family*
Email
ID Number*
gender* FemaleMale
Date of birth*
Phone *
Mobile *
Commitment start date*
Pledge amount*
(The minimum amount is 5 million Rials)
for several months*
(At least 6 months)
Please specify the payment method of your donation * Card to card, deposit to account (mandatory deposit notification)Site (online payment)Mobile applicationFace-to-face
Do you need a monthly reminder?* CallSMSemail
How to spend the amount paid * treatment and support services for cancer patients and their familiesdevelopment and equipping assistanceother cases
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