donation form

OPERA QUEENSLAND
DONATION FORM
Title: ______ First name: __________________ Last name: ___________________________________
Title: ______ First name: __________________ Last name: ___________________________________
Address: ______________________________________________________________________________
Suburb: _____________ State: ______________Postcode: ___________________________________
Daytime Telephone: ______________________Mobile: _____________________________________
Email: ________________________________________________________________________________
Please let us know if any details have changed. Update your details in the space below.
I would like to make a tax deductible donation to my opera company.
Donation amount: _____________
PAYMENT OPTIONS
Please find enclosed my cheque made payable to Opera Queensland Ltd
I have transferred the amount above to Opera Queensland’s bank account using this
reference: ______________________________________
(Please use your last name as a reference where possible)
BSB: 034-013
Account Number: 571115
Account Name: Opera Queensland Ltd Donations Fund
Charge my credit card the amount of $_______________
Visa or Mastercard Number
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Expiry _ _ / _ _
Cardholder name: ____________________________________________________
Signature: ____________________________________________________
Date:__________/__________/___________
Opera Queensland recognises donations of $500 and above in our Patrons Program,
website and annual report. Please indicate how you would like your name to appear:
_______________________________________________________________________________________
OR I wish to remain anonymous
Please return this form to Opera Queensland, PO Box 3677, South Brisbane QLD 4101