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Home
Our Cause
Albinism 101
Get Involved
About Us
Buy Kivuli
Register
KIVULI SUNSCREEN AID APPLICATION FORM
Register a beneficiary for Kivuli Sunscreen and or other selected benefits. Please note registration does NOT automatically guarantee aid. Our Terms and Conditions apply.
Beneficiary Details:
First Name
Surname
Date of Birth
Sex
Male
Female
Email
Tel
Address
Country
Zimbabwe
Zambia
Botswana
Malawi
Swaziland
Beneficiary's Next Of Kin/Guardian:
Next of Kin/Guardian Name
Next of Kin/Guardian Surname
Next of Kin/Guardian Email
Next of Kin/Guardian Telephone
Next of Kin/Guardian Address
Beneficiary Skin Conditions :
Any Skin Conditions
No
Yes
If Yes Please state the condition(s)
Other Requirements (For future use and or sharing with other charity organisations only):
Other Needs
Spectacles
Sun Hat
Medical Assistance - Cancer related
School Fees Assistance
Any Special Message to us:
Send Registration