International Society of Paediatric Oncology

Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund *	Membership Donation Fund or Select a Different Fund

Donation Information

Donation Amount *

€

NOTE:

The minimum donation amount is €10.00

Payment Method *

Credit Card

Please provide the name of whom you would like to sponsor (if known)

If you are donating to sponsor a member with a free SIOP membership for 1 year, please provide the name of the person and their email address (if known). If you don't want to name a specific person to benefit from a free SIOP membership, the SIOP Secretariat will assign a beneficiary. SIOP memberships start at 10 EUR/year for Low Income Countries. Thank you for your donation.

Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	/
Organization
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Billing Phone *

I hereby agree to pay with my credit card the SIOP membership fee for the above quoted number of SIOP membership years that I have chosen. I am aware that the SIOP membership years run from January 1 to December 31 of each calendar year. I understand and agree to auto-renew my SIOP membership for the same membership category and number of membership years that I have chosen above. I understand and agree that the auto-renewal of my SIOP membership will take place on December 31. I understand and agree that at least two weeks prior to auto renewal date, the SIOP Secretariat will inform me by e-mail on the upcoming auto renewal and give me a chance to change my credit card information or cancel my auto-renewal selection. I understand and agree that at any point before December 31, I can choose to stop the auto-renewal of my SIOP membership. I can stop the auto renewal myself by going into SIOP CONNECT, then clicking on PROFILE, then PAYMENTS & HISTORY, then MEMBERSHIP, and then deleting the outstanding invoice associated with the upcoming auto renewal. Alternatively, at any point before Dec 31, I can contact the SIOP Membership Coordinator at membership@siop-online.org to request him to stop the auto-renewal. I agree to keep an up-to-date e-mail address associated with my account on SIOP CONNECT in order to facilitate communications about SIOP activities and membership renewals.

I Accept the Terms of Use

The Cardholder stated above has authorized this payment. If this payment is part of a recurring series of payments, the Cardholder understands the terms and amounts of those recurring payments, and authorizes payment for each of them. Cardholder consent will expire once all scheduled recurring payments have been processed, or if all future recurrences are cancelled. The Cardholder acknowledges that specific payment dates may vary. Examples include, but are not limited to: payment dates falling during weekends, holidays, or during system outages. In order to facilitate the processing of those recurring payments, stored credentials will be used. Those stored credentials will only be used to process payments that are part of this series of recurrences. In order to use those stored credentials for any other payment, Cardholder re-authorization will be required. In the event that a consent agreement must be modified, the new agreement will be sent to the email address associated with the invoice.

The Cardholder understands the terms and authorizes the payment(s).

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