Donation Form

Name
Address
Phone
email

 

Would you like a reciept ?	Yes   No
Would you like to be kept anonymous ?	Yes   No
Amount of Donation $
Amounts over $2 are tax deductible
My cheque is enclosed or debit my	Bankcard Visa Card MasterCard American Express Diners

 

Card Holder's Name
Account No.
Expiry Date
Signature

 

Please print out this form and post to:

 

The Royal Society For the Blind

GPO Box 1855 Adelaide, 5001

 

 

 

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