Lizard Island Research Station - Lizard Island Reef Research Foundation Donation Form

Lizard Island Reef Research Foundation Donation Form

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Lizard Island Reef Research Foundation Donation Form

I wish to make a contribution to the Lizard Island Reef Research Foundation (up to $1,000 for Friends; $1,000 or more for Members).

Name:

Address:

Phone:

Fax:

Email:

Payment method

Payment by cheque

Enclosed is a cheque for $

(Payable to the Lizard Island Reef Research Foundation)

Payment by creditcard

Please charge $ to my:

Mastercard Visa Amex

Number

Expiry

Name on card:

Would you like your name and that of your partner to be included in any public listing of contributors?

Yes No

Donations are fully tax deductible within Australia. A receipt will be issued.

Details will not be sent over the internet.

Please print and fax or mail this form to:
Gail McCarthy
Lizard Island Reef Research Foundation
Australian Museum
College Street
Sydney NSW 2010
AUSTRALIA
Phone: (+612) 9320-6157
Fax: (+612) 9320-6074

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