Batting for Battens Incorporated

22 Cambridge Place, Wishart, QLD, 4122

ABN 40 931 835 917 Endorced DGR

Donations over $2 are Tax Deductible

DONATIONS

Make A Donation

A gift will help support and promote the highest-quality research world-wide into the cause, care and cure of Battens Disease.

To make your gift, call (07) 3161 4455 or please fill out and print this form , then mail it (with your cheque, money order, or credit card information) to:

The Secretary
22 Cambridge Place

WISHART

QLD 4122

Make checks payable to: Batting for Battens Inc.

I would like to contribute:

$10		$50		$100
$25		$75		Other $

Donation Details

This donation is:
	In Honor of		In Memory of		Name

If you make a donation on a person's behalf, please provide the address and individual you would like an acknowledgment letter sent to.

Name
Address
City	State
Post Code
Country
Email Address

Payment Information

Name
Address
City	State
Post Code
Country
Email Address
Phone

For credit card donations, please provide the following info:

Name on Card
Credit Card  Visa  Mastercard American Express Discover
Card Number
Expiration Date	/ (MM/YY)
Signature	_________________________________________

"Optional Questions"

My preferred method of contact is: Email  Phone  Mail

How did you hear about us?

Comments or Suggestions