Business or Organisation Membership Form

Business or organisation name

Preferred contact name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Contact Email Address

Preferred Phone

(###)

###

####

We wish to contribute

An annual contribution of $1000

We would prefer to donate the amount shown below:

Our method of payment is:

Paid by cheque, made out to Aoraki Foundation and posted to: PO Box 983, Timaru.

Paid by direct debit to Aoraki Foundation account number: 02-0888-0060224-00. Please put the name of your group or organisation in the reference field.

Paid by automatic payment. We would like to donate the amount shown below:

Note: the Aoraki Foundation will provide you with a taxation receipt which as a donation is eligible for a 33% tax rebate.

FRIENDS OF AORAKI

Business or Organisation Membership Form