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Donation Report Form
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* Indicates required question
nickname
*
Your answer
Real name
Your answer
Country of Citizenship
*
Your answer
Types of remitted cryptocurrency
*
Bitcoin (BTC)
Bitcoin Cash (BCH)
Ethereum (ETH)
NEM (NEM)
Donation amount
*
Your answer
Remittance date
*
MM
/
DD
/
YYYY
Remarks column
Your answer
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