Post to:

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

Or Fax: 06 769 5400

I am interested in becoming a Hearing Dog socialiser for Hearing Dog for Deaf People New Zealand.
Please send me further details.

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

Email: info@hearingdogs.org.nz