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Order Form - Eye of the Needle |
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NOTE: To order print the completed form then mail or fax it with your payment to the address below. This form can not be submitted online. |
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Send the completed form below with cheque or money order to: Or Fax printed form with payment details to: +61 (2) 9794 1910 |
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Contact Details |
Payment Details |
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Title |
Cheque to: Friends of STARTTS |
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Name |
Money Order to: Friends of STARTTS |
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Surname |
Credit Card (Bankcard/Master Card/Visa) |
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Organisation |
Card Holder's Name |
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Address |
Card Number |
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Town |
Expiry Date |
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State |
Signature |
________________ |
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Post Code |
Date |
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Country |
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Telephone (H) |
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Telephone (W) |
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Total Cost |
(see below) | |||
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Cost: A$150.00 for organisations with an annual budget of more than A$350,000 A$120.00 for organisations with an annual budget between A$350,000 and $80,000 A$100.00 for organisations with an annual budget of less than A $80,000 Include A$4.50 for postage and handling within Australia and A$12 Outside Australia. Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (NSW) - Order Form |
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