The Graeme Clark Foundation

Donation Form and Tax Receipt

Postal Address:

The Graeme Clark Foundation PO Box 2031 East Ivanhoe, Victoria 3079 Australia 43 796 278 877 +61 3 8677-2513 +61 3 8677-2513

ABN: Phone: Fax:

Personal Details
Title: First Name: Surname: Company Name:
(If applicable)

Address: Town/Suburb: Post Code: Telephone: Fax: Email:

Payment Details
I enclose my cheque / money order payable to the Graeme Clark Foundation:

Date: Donation Amount: $ Donations of $2 and over are tax deductible.

Thank you for supporting the Graeme Clark Foundation.