Shipping viagra to australia - Young Media Australia

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Section 1
- I am interested in supporting the KIDS FREE TO BE KIDS campaign. I would like to:


Make a tax deductible donation.
YMA is endorsed as an income tax exempt charity entity and as a deductible gift recipient – donations of
$2 or more are tax deductible. Please complete Sections 2 & 3 of this form.


Keep in touch with developments by email. Please complete Section 2 of this form.
Section 2
– My details

Name

……………………………………………………………………………………………………………………

Organisation

……………………………………………………………………………………………………………………

Address

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

………………………………………………………………………………..Post code……………............

Phone

........................................................ Fax …………………………………………………

Email

………………………………………………………………………………
Section 3
– Payment details

Amount ………………………..


Please find enclosed cheque (payable to Young Media Australia)

Credit card details

Visa

Mastercard
Name on card :…………………………………………………………………..Expiry date : ....../…….
Card no:

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Signature : ………………………………………………………………….. Date :………………..
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A joint project with
YOUNG MEDIA AUSTRALIA

Support Form

Please return this form to:
Young Media Australia, PO Box 447, Glenelg SA 5045 or fax to ( 08) 8376 2122