TO MAKE A DONATION TO THE ARI PLEASE PRINT THIS FORM BEFORE YOU COMPLETE IT.
(Use the print icon toward the top right of this page.)
Then post or fax to address below.

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I WISH TO: 

                      
[    ] Become an 'Associate Member' of the ARI         

[    ] Support child health                     

[    ] Donate to where most needed                          

(Donations of $100 or more qualify you to become an ‘Associate Member’ of the ARI.)

NAME: ________________________________________

ADDRESS:_________________________________________________________

__________________________________________________________________

__________________________________________________________________

TELEPHONE Number:_____________________________

Your gift of support (over $2.00) is tax deductible.

My cheque of $_____________ is enclosed

Please debit  $ ______________ from my (PLEASE CIRCLE)

Bankcard     Mastercard     Visa      Diners     Amex

Card No: __ __ __ __     __ __ __ __     __ __ __ __     __ __ __ __

Signature:______________________ Expiry date:_______________

 Kindly send your fully tax deductible donation to:

Australasian Research Institute @ Sydney Adventist Hospital.
185 Fox Valley Rd, Wahroonga, NSW 2076 or Fax: 02 9487 9626

All donations to the ARI are held in trust by the Sydney Adventist Hospital Foundation Inc