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Yes, please accept my donation to the Environment Defenders Office (Victoria) Ltd Gift Fund to help defend the environment.
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First Name: _________________________ Last Name: ____________________________
Organisation/Group: _____________________________________________________________
Address: ______________________________________________________________________
_____________________________________________________ Postcode: ______________
Tel:
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( ) __________________________
E-mail: ___________________________________________________________________
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PAYMENT DETAILS
Donation
Amount $ ________________
(Note: Donations $2.00 and over are tax-deductible)
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(Victoria) Ltd)
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__ __ __ __ __ __ __ Expiry:_____/______
Cardholder Name: __________________________________________________________
Signature:_________________________________________
Date: ____/____/____
Thank
you! Please complete all details and return with payment to the EDO:
—by post: PO Box 12123, A'BECKETT ST VIC 8006
—by fax: (03) 8341 3111
Environment Defenders Office (Victoria) Ltd, ABN 74052124375