Boomerang Project

Donation Form

Visa/MasterCard/ Cheque (Please Circle )

Cardholder's Name_______________________________

Credit Card Number_______________________________

Expiry Date____________

Cardholder's Signature ______________________________

Your Address_______________________________

Postcode_______

Your Telephone Number_____________________________

Please send donation forms with cheques (if applicable) made out to:

Apheda (Boomerang Project)

3^rd fl., 377-383 Sussex St., Sydney 2000.

Or fax your forms to: (02) 99048277

Telephone enquiries to Geoff Mymin-93888151 or Di Singer 0411577151