Yes! I would like to contribute to the IT 4 Republic

Please fill out this form, then print it and fax or post it to us. Anonymous donations are also welcome and may be sent by money order to the postal address below.
POSTAL ADDRESS: P.O. BOX R709 ROYAL EXCHANGE NSW 1225	FAX NO: (02) 9251 9808 ENQUIRIES: (02) 9251 9807

Credit card details:

Bankcard  Mastercard  Diners Club

Visa  Amex

Date today
Name on card
Account Number		Expiry Date
Amex only:		Diners only:
4 Digit ID		Member since

Select Contribution level:

General	ARM Membership	Y2K+1 Membership
$20  $30  Other $	Standard - $40  Family - $60  Foundation - $200	Y2K+1 - $2001  Other $

Contact details:
Your Name
Email address
Tel No:		Fax No:
Postal address

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