BIG SCRUB RAINFOREST LANDCARE GROUP
ABN 44 919 192 078
Donation Form

Donations will allow further rehabilitation and maintenance work in the surviving remants of Big Scrub rainforest to continue to help save this Rainforest and its magnificent biodiversity.

Thank you so much for your kind donation

I (name) ............................................................................

of (address) .......................................................................................................................................................

would like to donate

......$10

......$20

......$50

......Other amount $...................................

Contact phone no:: ..............................Email Address: ..............................................................

Please return this form to John Leedom, BSRLG, 194 Kings Rd. Federal, NSW 2480,

together with a cheque or credit details ... Thank you again

........Tick here if you would like a receipt to be sent to you as all donations are tax deductable

My e-mail address is:....................................................

My telephone number is:...............................My fax number is:...............................................................

I wish to pay by

Cheque

Money Order

Credit Card

Cash

(Please circle your choice)

Please make cheques and money orders payable to the BSRLG. If paying by credit card please provide the following details:

MasterCard

Visa

Bankcard

(Please circle the appropriate card)

Card No:

Card Expiry Date: ____ / ____/ ____

Name on card: ___________________________________Cardholder's signature: _________________________