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Organisation Contact Details

Appeal Name:	Ian Thorpe's Fountain for Youth Supporting Literacy and Health Education for Aboriginal Children
Organisation Name:	Ian Thorpe's Fountain for Youth
Address:	PO Box 402 MANLY NSW 1655
Fax:	02 8214 3426
Phone:	02 9949 1356

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Email:

Payment Details — Please Print Clearly

I would like to donate		$	to Ian Thorpe's Fountain for Youth
	Enclosed is my cheque / money order
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Credit Card Details

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Expiry Date:	/	CVV:
Cardholders Name:
Signature:
Date of Donation:

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