Donations are still needed – your support is essential and greatly valued. Your contributions
ensure we are able to continue our services for people with dementia, their families and
friends. All donations of $2 or more are tax deductible and receipts are forwarded for all
donations.
Mr / Miss / Mrs / Ms
Surname: ______________________________________________
First Name: __________________________ Other Name: __________________________
Organisation (if applicable):___________________________________________________
Address: _________________________________________________________________
Suburb: _________________________________ Postcode: ________________________
Phone: ________________________ Facsimile: _________________________________
Email: ___________________________________________________________________
I wish to make a donation of:
$200
$100
$50
$20
$10
Other $________
I have made payment by:
 Cash
 Cheque payable to Alzheimer's Australia NT Inc
 EFT Payment:
EFT Payment details:
Bank account name: Alzheimer’s Australia NT Inc
BSB number: 633 – 000
Account Number: 135628709
Credit Card:
Please go to www.fightdementia.org.au click on Northern
Territory and follow the prompts.
Return by mail to:
Alzheimer’s Australia NT Inc
ABN 34 030 043 531
PO Box 515
Nightcliff NT 0814
________________________________________
Signature
T: 08 8948 5228
F: 08 8948 5229
E: [email protected]
______________
Date