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I wish to Become a Manning Clark House Benefactor
I wish to give an annual gift of

per year until I cancel
More than $1000 pa - please specify $
 

 
I wish to pay by Cheque for $ made out to Manning Clark House

C redit card (Please select)

Credit Card Details  
Card Number
Expiry Date
Name on Card
Signature

Your gift is fully tax deductible, and a receipt will be sent to you.

Your Name
Your Address (to post your receipt)
Suburb/City
State Postcode

Before you post this form please ensure that you have:

Completed all required details
Completed your name and address
Enclosed your cheque payment
Signed the credit card authorisation after the form has been printed

When all details have been completed please print this page and post it to:

Manning Clark House
PO Box 3096
Manuka ACT 2603

Thank you for your support.

©2002-present Manning Clark House Inc. ABN 39 997 015 544
11 Tasmania Circle, Forrest, ACT PO Box 3096, Manuka, ACT 2603
Telephone: +61 (02) 6295 9433 email: manningclark@ozemail.com.au