AUSTRALIAN PLATYPUS CONSERVANCY
Platypus Sponsorship Form
Name:_______________________________________________(BLOCK
LETTERS)
Address:_______________________________________________________________
Post code:_______________________Tel
No.________________________________
I wish to sponsor the following
platypus:
|
PLATYPUS |
Sponsored
platypus (place
an X next to |
Name of person to appear on sponsorship certificate |
|
Double Trouble |
|
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Firefly |
|
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Muddy |
|
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Pumper One |
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I am paying for:
|
TOTAL SPONSORED |
AMOUNT |
Place an X next to |
|
One platypus only |
$15.00 |
|
|
Two platypus |
$25.00 |
|
|
Three platypus |
$32.50 |
|
|
All four |
$40.00 |
|
Please note that all prices are in
Australian dollars.
Enclosed is a cheque/money order for
$_____
(payable to Australian Platypus
Conservancy)
OR
Please charge my
VISA/Mastercard/Bankcard No.
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Expiry date:_____________________
Name of
Cardholder:_____________________________________
Signed:__________________________Date:__________________
Copy
this page and send to:
Australian Platypus Conservancy
Box 22
Wiseleigh VIC 3885
Tel: (03) 5157 5568
Email: platypus.apc@westnet.com.au