Pledge Form

Name of Individual or Organisation:_

Address:__

Suburb:_

Phone:_

Postcode:

Email:

I/we offer ray/our support of the Anam Cara House Fundraising Appeal $10, $20, $50, $100, $500

I/we confirm my/our pledge of $

and enclose cheque here with.

If you wish to become a member please contact Anam Cara I louse.

Signature:-Date:-

Position (if applicable):_

Note: Supporters of this appeal will be recognised in (be media and personally by die

Anam Cara House Capital I'undraising Committee. EFT contributions may be made at any time - Bank deposit details are: Bendigo Bank: BSB 633-000; Capital Fundrasing Account No: 128787173 Please return or post deposit advice to: Anam Cara House - Colac P.O. Box 508 Colac Vic 3250 PU:0427 895956

Anam Cara House - Colac has Tax Deductible Gift Recipient Status. All donations $2 and over arc tax deductible. Thank you for your generous gift.

www.anamcarahousecolac.org.au

further infomation contact Diane Wright on 0427 895 956(Donations Over $2 are Tax Deductible)

BIKE INSTRUMENT REPAIRS & RESTORATION

SMITHS CHRONOMETRIC& MAGNETIC MOTO METER VE6LIA VDO

NIPPON SEIKI NIPPON DENSO

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