TPC Pledge Form

Name:

Organisation (if applicable): _______________________________________

Foundation /Trust Name (if applicable: ____________________________

Address:

Email:

Phone Number:

Pledge Amount:

[ ]$80Inhonourof80years

[ ]$150Helpachildexperienceadayatcamp

[ ]$500Providesafullscholarshipfora3-dayprogram

[ ]$1000Providesafullscholarshipfora5-dayprogram

[ ]Otheramount

Total Donation Amount: $

: ________________________________________

DONATEONLINE

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@theportseacampcomau 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.