I, (surname, name),
have sent the Academy
(amount of money)
as my voluntary donation using the Academy account.
(Optional:) I want to receive a certificate on my participating the Academy.
I know that I may receive the name of a sponsor of the Academy only if my total voluntary donation is not less than the current least value defined by the presidium of the Academy and that this value is presently
100 € (a hundred euro).
Then I may ask you to place at your Web site my surname and name as a link to the following information (e.g., the names of products and/or services, telephone numbers, post, e-mail, and Internet addresses, etc.):
Place, country:
Date:
Signature: