PLEASE PRINT THIS FORM AND FILL IN THE RELEVANT DETAILS
    
I would like to help SIDS and Kids Tasmania's work by making a donation:
(Donations over $2.00 are tax deductible)

Enclosed is my gift of $ ____________  Cheque [   ]                Money Order  [   ]
(Please make out cheques or money orders to SIDS and Kids Tasmania))

or please debit my:

Bankcard  [    ]     MasterCard  [    ]     Visa [    ]    Diners Club  [    ]     Amex  [    ]
       
 
       
 
       
 
       


Expires on ____________________


Signature ___________________________________________

I would like more information on:

becoming a volunteer  [   ]        having a speaker  [   ]        making a bequest  [    ]

Name: Mr/Mrs/Ms/Miss/Dr

Address

Postcode

Email

Phone No:
H:  


W:

  
Please address your envelope to:

SIDS and Kids Tasmania
2 Spring Street, Burnie  Tas  7320

Tel 1300 308 307 or Fax 1300 308 317
(only the cost of a local phone call)
Email: tasmania@sidsandkids.org