Mail to: WIRES Wollondilly, PO Box 63, Bargo, NSW, 2574
Please print and complete the fields below. Fields marked with * are mandatory.
* Name: _________________________________________________________
*Surname: _______________________________________________________
*Business Name: _________________________________________________
*Address:________________________________________________________
*Suburb:__________________________________ *Postcode: _____________
Phone:__________________________________________________________
Email: __________________________________________________________
* I would like to donate $____________________
enclosed is my cheque / money order.
Alternatively you can donate to your local branch at http://www.wires.org.au