The William Hill & Son Grand Organ Restoration Appeal

I/We ............................................................. .....................................................................

Address .......................................................... ..........................Postcode.....................

Telephone Private................................ Business .............................

I/We wish to make a donation towards the William Hill & Son Grand Organ Restoration Appeal

I/We wish to donate $__________
My/Our cheque is enclosed

I/We wish to donate $__________ over two financial years, this year's contribution is enclosed.

(please tick the appropriate box)

Payment by: Cheque Visa Mastercard
Amount ......................................

Card number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

Expiry date ........................................

Name on card ..................................... ................................................................
Signature
................................................................
Date

To ensure Tax deductibility please make cheque payable to:
Organ Historical Trust of Australia

Send this form with your donation to:
Organ Historical Trust of Australia Grand Organ Restoration Appeal
PO Box 178 Blackwood, SA 5051

Receipts will be provided