DONATION FORM

To make a donation in support of your Museum, please print the form below and post it to the address stipulated:

Yes, I wish to support the important work of the Western Australian Museum

Title ...........

First Name ...................................................

Last Name ..............................................................

Address ....................................................................

Suburb.................................State..........................Postcode...............................

Day time Contact Number ..................................................................

Email .....................................................................

I would like to make a donation of A$.................................................................

I enclose my cheque made payable to the Western Australian Museum Foundation

Or

Please charge my credit card :

Card Number ____ ____ ____ ____

Expiry Date......................... Amount $.................................................

Cardholder Name..............................................................

Cardholder Signature........................................................

Date.............................................

The Western Australian Museum Foundation is as a registered Deductible Gift Recipient and as such all donations over $2.00 are fully tax deductible.

Please print and forward this completed form and your contribution to:

Karen Bassett
Development Coordinator
Western Australian Museum Foundation
Western Australian Museum
Perth Cultural Centre James Street, Perth, WA 6000
Tel: +61 8 9427 2766  Fax: +61 8 9427 2827
Email karen.bassett@museum.wa.gov.au