Login to My Giving

Email:Password:

Join GiveNow to access My Giving

• view all your donations
• setup regular donations
• get donation summaries for your tax return

Print out the donation application below to:

• Send to your chosen organisation with your credit card details, cheque or money order
• Fax to your chosen organisation with your credit card details

---

Organisation Contact Details

Appeal Name:	Access to Mobility
Organisation Name:	Motivation Australia Development Organisation
Address:	PO Box 17 WILLUNGA SA 5172
Fax:
Phone:	08 8556 4423

---

Donor Details — Please Print Clearly

	Tick if you would like to remain anonymous (NB A tax invoice will not be sent)
Name:	Title	First Name	Last Name
Address:
	Suburb	State	Postcode
Phone:	Home	Work
	Mobile	Fax
Email:

Payment Details — Please Print Clearly

I would like to donate		$	to Motivation Australia Development Organisation
	Enclosed is my cheque / money order
	Please charge my credit card

Credit Card Details

Card Type:	VISA   Mastercard   AMEX
Card Number:
Expiry Date:	/
Cardholders Name:
Signature:
Date of Donation:

---