Individual or Family Membership Form

Friends of the Aoraki

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

(###)

###

####

I wish to become a Friend of Aoraki:

Individual (suggested $500 per annum)

Couple or Family (suggested $1,000 per annum)

I would like to donate another amount

Amount

Enter the amount you'd like to donate

My method of payment is:

Paid by direct debit /internet banking to the Aoraki Foundation operational account: 02-0888-0060224-00. Please put first and last name in reference field.

From my pay. If you intend to donate directly from your pay please contact your HR team and provide them with our details (Aoraki Foundation CC42601).

Paid by automatic payment (weekly/fortnightly/monthly/annually).

I/we would like the following name to appear on the Aoraki Foundation website.

I/we would prefer to remain anonymous.

Note: A tax deduction is available to a business for the donation or a rebate claim at 33% for an individual. A receipt will be provided by Aoraki Foundation for taxation purposes.

FRIENDS OF AORAKI

Individual or Family Membership Form