Donation Form - www.hearingdogs.org.nz
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Post to:

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

Or Fax: 06 769 5400

Please accept my donation to Hearing Dogs for Deaf People New Zealand

Mr/Mrs/Ms/
Miss/Dr/other:  		_____
Name: ________________________________________
   
Postal Address: ________________________________________

________________________________________

________________________________________
   
Phone: ___________________ Fax:__________________
   
Email: ________________________________________
   
   
Signed: ________________________________________

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.

Email: info@hearingdogs.org.nz