Donations Form

Donations Form

Thank you for your support of our club. We could not work with the community to remove barriers to engaging in physical activity without your help.
DONATION AMOUNT

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NZD
We are a registered charity. Do you require a receipt for tax purposes?*

YesNo
Do you wish to remain anonymous?*

YesNo

You only need to provide your personal information if you require a receipt and/or do not wish to remain anonymous.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email
example@example.com
Any comments/feedback you would like to offer?

Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: