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By submitting this form, I, the undersigned, confirm that I have agreed to make a donation to Wilderness Therapy Namibia via monthly payments. By submitting this form, I hereby instruct and authorize Wilderness Therapy Namibia to draw against my bank account with the set amount which is due and payable by me in terms of this agreement. This debit order will remain effective until cancelled by me in writing. I may choose to cancel this debit order instruction at any time, giving 30 days' notice in writing. I agree to pay any bank charges relating to this debit order instruction. All debit orders are administered by Wilderness Therapy Namibia.

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