Yes, I want… a maatje (buddy)

[] to go to				[] to baby-sit my children

[] the hospital

[] the social services office

[] a lawyer

[] the embassy

[] the pharmacist

[] the Ron Wichmanhuis

[] other………………………

Name		………………………………
Telephone	………………………………


You can send this form, without stamp, to
Humanitas, MaatjesProject Bureau Hiv-hulpverlening
Antwoordnummer 20508
3020 WB  Rotterdam

Or call 010-425.01.04.