THE P RTSEA CAMP Name: _______________________________________________
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BRIGHTER FUTURES FOR EVERY CHILD
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NATE ON
Organisation (if applicable): _______________________________________ Foundation /Trust Name (if applicable: ____________________________ Address: ___________________________________________________________ Email: ______________________________________________________________ Phone Number: ____________________________________________________ Pledge Amount: [ ] $80 In honour of 80 years [ ] $150 Help a child experience a day at camp [ ] $500 Provides a full scholarship for a 3-day program [ ] $1000 Provides a full scholarship for a 5 -day program [ ] Other amount Total Donation Amount: $ : ________________________________________ Donation Method: [ ] Online (Scan QR code above) [ ] Direct Bank Deposit [ ] Cheque Direct Bank Deposit: Bank: Account Name : The Portsea Camp BSB 633 000 | Account Number 131 853 848 Reference: Donor’s Name Please email your contact details to events@theportseacamp.com.au to receive tax receipt Cheque Payment: Please make cheques payable to The Portsea Camp and mail along with this form to: The Portsea Camp 3704 Point Nepean Rd Portsea, VIC 3944 Tax Receipt Request: [ ] Yes [ ] No All tax receipts will be emailed to donors Thank you for your generous donation to support children facing barriers to opportunity. Your contribution will make a significant impact on their lives.