Addition to the Application-Questionnaire

to send the Academy

a voluntary donation from an organization

I, (surname, name),

want to send the “Dominanta” Academy of Culture

(amount of money)

as my voluntary donation

and need the Academy account.

I know that (organization name) may receive the name of a sponsor (of the Academy) only if its total voluntary donation is not less than the current least value defined by the presidium of the Academy and that this value is presently

1000 DM (a thousand DM).

(Optional:) Then I ask you to send me a certificate that (organization name) is a sponsor of the Academy.

Then I may ask you to place at your Web site (organization 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: