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IN MEMORY DONATION Please find my enclosed gift of: $_______________________ ‰

Yes, I would like a receipt mailed to me.

Your receipt will be mailed to the postal address provided below. (Donations $2 and over are tax deductible.)

Name: (Title)

(First name)

(Surname)

Postal Address: (Address line 1)

(Address line 2)

(Suburb)

Phone:

(State)

(H)

(B)

(Postcode)

(Mob)

Email: Age group:

‰ Under 18

‰ 18-24

‰ 25-39

‰ 40-54

‰ 55+

‰ My cheque/money order is enclosed, made payable to St Vincent de Paul Society and marked Not Negotiable. ‰ Please charge my credit card: ‰ Visa

‰ Mastercard

‰ American Express

‰ Diners Club

Card Number:

Expiry Date:

Signature:

Next of Kin details: Please provide so that we can notify the family of the deceased the names of people who have donated in memory of their loved one.

Name: (Title)

(First name)

(Surname)

Postal Address: (Address line 1)

(Address line 2)

(Suburb)

(State)

(Postcode)

Name of the deceased: ______________________________________________________________ (Please print name)

Would you like more information on: ‰ Our direct debit donation program? ‰ Making a gift in your Will? On December 21, 2001, the new provisions of the Privacy Amendment (Private Sector) Act 2000 commenced. This legislation updates the Privacy Act of 1988 and is designed to protect your rights with respect to personal information held. The St Vincent de Paul Society follows these national privacy principles.

http://vinnies.org.au/files/VIC/Howyoucanhelp/InMemory/In%20Memory%20Form%20-%20VIC%20only  

http://vinnies.org.au/files/VIC/Howyoucanhelp/InMemory/In%20Memory%20Form%20-%20VIC%20only.pdf

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