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D
ONATE
N
OW
!
To donate now please complete the following form. When you click
submit
your details are sent through to a staff member at the
YMT Head Office
. They will contact you as soon as possible to confirm further details on how you wish to donate. Thanks!
D
ONATE
N
OW
F
ORM:
Donation Type:
Personal
Company
Personal/Company Details:
Surname:
First Name:
Title:
Position (if Company):
D.O.B. (DD/MM/YEAR):
Employer/Company/Organisation:
Address:
Suburb:
Postcode:
State:
Who referred you to YMT:
Contact Details:
Home:
Mobile:
Business:
Fax:
Email:
Donation Details:
I would like to become an
Eternal Change Partner
& support:
YMT Australia
OR
YMT
Sydney
Melbourne
Perth
Wollongong
I would like to give an
ongoing
amount of:
$5 per/wk
$10 per/wk
$20 per/wk
$50 per/wk
$100 per/wk
Another amount
another amount: $
per/wk
OR
I would like to give a
one-off
donation of:
$
Please choose your method of payment:
Deduct my
credit card
(processed monthly for ongoing amounts)
Direct debit
my bank account
(process monthly for ongoing amounts)
I will forward a
cheque/money order
, please send me a reminder
