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Hearing Dogs for Deaf People New Zealand
PO Box 8117
New Plymouth

Please print this page, complete the details of your donation and post to the address as shown above.

Yes !  I want to donate to Hearing Dogs for Deaf People New Zealand

Mr/Mrs/Ms/
Miss/Dr/other:      _____
Name:     ______________________________________________________
     
Postal Address:     _____________________________________________
    
______________________________________________________________
    
_______________________________________Post Code:_____________
     
Phone:     ______________________ Fax:__________________________
     
Email:     _____________________________________________________
     
     
Signed:     ___________________________________________________

(Optional) Enclosed my donation of: $

(Cheques payable to 'Hearing Dogs for Deaf People NZ')

I wish to pay by     Mastercard                Visa
Card Number:     ____________________________________________
     
Name on card:     ___________________________________________
     
Expiry Date:     _____________________________________________

Donations of $5 or more are tax-deductible. We will send you a receipt.