Become one of the 3 000 co-founders
of the bio-medical laboratory !

Total cost 150 000 euros
divided into 3 000 "building blocks" worth 50 euros each

I want to help in setting up the laboratory :


I want to purchase one building block and will pay 50 euros
I want to purchase two building blocks and will pay 100 euros
I want to purchase three building blocks and will pay 150 euros
I want to purchase building blocks (50 euros each) and will pay a total of euros.


In the interest of transparency, the list of co-founders/contributors for the bio-medical laboratory will be available on the CRIIRAD site.
I accept that my name and town be listed among the co-founders
My contribution may be listed, but do not give my full name (only my initials and the town).

Payment
I will pay by: check (sent by postal mail)
Address: CRIIRAD, 471 avenue Victor Hugo, 26000 Valence, France

bank transfer to CRIIRAD BFCC Valence 42559 00013 - 210258 46604 - 41
If you are transferring from a foreign country to France, the international code is:
IBAN FR 76 4255 9000 1321 0258 4660 441


On receiving your payment, we will send confirmation and a certificate for the tax deduction. You will be listed among the contributors.

Contact information :

Last name First name

Address

Address (cont.)

Postal code City

E-mail Country
Telephone Fax


Use of your contact information is subject to article 27 of French law dated 6 January 1978.
You may request correction or deletion of the information.
Your information will be used exclusively by CRIIRAD. It will NOT be sold or released to third parties.
If on clicking below to confirm, the system presents a blank page,
your navigator version is not compatible.
In this case, simply send us a Word file with the necessary information, attached to an e-mail.

 

 

 

Main page

If you want to help CRIIRAD, become a member HERE