order form - Sids and Kids

Friday 24th June 2011
in June for
Supporting Red Nose Day couldn’t be easier!
Simply call us or complete this form and return it to SIDS and Kids NSW. Our details are over the page
SUPPORTER NO. (if known):
TITLE:
ORGANISATION / SCHOOL / GROUP:
FIRST NAME:
SURNAME:
STREET ADDRESS:
SPECIAL DELIVERY INSTRUCTIONS:
POSTAL ADDRESS:
EMAIL:
* to receive further Red Nose Day updates, please provide email address
PHONE:
MOBILE:
WORK:
FAX:
Order a Red Nose Day merchandise Box
(includes Box, Mixed Product, Instructions for selling and return of money collected.)
QTY: _____ Red Nose Day Product Box @ $100.00 per box
QTY: _____ Red Nose Day Lapel Pins Box @ $200.00 per box
Purchase Red Nose Day Tattoos
QTY: _____ Red Nose Day Tattoos, packs of 5 @ $10.00 per pack
(non returnable / non refundable)
I would like to hold a
Do It In Red event to fundraise
for Red Nose Day - Please email
me my Fundraising Kit
Order other selected Red Nose Day items.
QTY: _____ Red Noses, pack of 6 @ $12.00 per pack
QTY: _____ Brontosaurus Dinosaur Soft Toy, pack of 5 @ $30.00 per pack
QTY: _____ Bracelet, pack of 2 @ $6.00 per pack
QTY: _____ Lip Balm, pack of 5 @ $12.00 per pack
QTY: _____ 4 in 1 pen, pack of 8 @ $40.00 per pack
QTY: _____ Plastic Car Nose (incl cable ties) @ $5.00 each
QTY: _____ $5 Lapel Pin, pack of 10 @ $50.00 per pack
QTY: _____ $10 Lapel Pin, pack of 5 @ $50.00 per pack
QTY: _____ $20 Lapel Pin, pack of 5 @ $100.00 per pack
I would like to Volunteer for
Red Nose Day, I would love to
help! - Please contact me with more
information
I would like to order my product:
CARD TYPE (please tick):
on consignment OR
pay upfront (no refunds available)
MASTERCARD / VISA
NAME ON CARD:
CARD NUMBER:
SIGNATURE:
EXPIRY DATE:
in June for
Friday 24th June 2011
SIDS and Kids NSW cares for families across the state who have experienced the death of their baby or young
child for any reason during pregnancy, birth, infancy and childhood. This includes miscarriage, stillbirth, neonatal
death, sudden infant death (SIDS) and the death of a child up to 6 years of age. We offer 24 hour bereavement
support, counselling, group support and community education.
Through our safe sleeping program we have been able to help reduce the incidence of SIDS by over 85% in the
past 17 years. The unfortunate truth is we are still supporting many grieving families who have lost their baby or
young child. SIDS and Kids supports families regardless of how their loss occurred - because every baby is
special.
Red Nose Day has been our biggest fundraising and awareness building day each year for the past 24 years.
We hope to make this year even bigger and get our message out there to as many people as possible. You can
help by hosting your own fundraising event, decorating in red, putting up posters and helping raise money and
awareness in your area.
REGISTER NOW TO DO IT IN RED FOR RED NOSE DAY BY:
Email: [email protected]
Post: PO Box 431, Camperdown NSW 1450
Phone: 1300 1 RED NOSE (1300 1 733 6673)
Fax: (02) 9818 4555