I would like to support Co3
YOUR DETAILS
Title
First Name
Last Name
Suburb
State
Post Code
Phone
Email
Address
I would like to receive Co3 eNews.
I would like to make a tax deductible donation to Co3 of:
$250
$500
$1,000
$5,000
Youth
Education
$10,000
Other $
I wish to direct my support towards:
Our Dancers
New Works
PAYMENT OPTIONS
Co3 is endorsed as a Deductible Gift Recipient (DGR). All donations over $2 are tax deductible.
I have enclosed a cheque made out to the ‘Contemporary Dance Company of WA’
I have made a direct deposit to:
Contemporary Dance Company of WA
BSB: 036 022 Account No: 356 854
Please include your surname for reference.
I have made a donation online at co3.org.au/support
Please charge my credit card
MasterCard
Visa
Amex
Card Number
Expiry Date
CCV
Cardholder Name
Cardholder Signature
RECEIPT
Please issue my receipt in the name provided
above.
Please issue my receipt in the name of:
I would like to receive my receipt via email.
I would like to receive my receipt by post.
ACKNOWLEDGEMENT
I would like my contribution to remain
anonymous.
Please acknowledge my contribution in the following name:
I would like someone to call me to further
discuss my contribution.
Please send me information on how to make a bequest to
Co3 Australia.
SUBMIT
Please return your completed form to Co3 by post, fax or email.
Co3 Australia
PO Box 7009 Cloisters Square, Perth WA 6850
e. [email protected] | f. 08 9226 2323 | w. co3.org.au
THANK YOU FOR YOUR CONTRIBUTION