Make a Donation

For on-line payments please complete the subscription form below and make your payment to ....
Lupus Trust NZ, BNZ account 02-0168-0296976-00
Under payee details enter your name for reference and donation for particulars.

If paying by cheque please PRINT this donation form and post, together with your cheque to:
The Secretary, Lupus Trust of NZ, P O Box 249, Silverdale, Auckland 0944

Please make cheque payable to The Lupus Trust of NZ

Post to:
The Secretary
Lupus Trust of NZ
P O Box 249
Silverdale
Auckland 0944

Fields marked * are Required fields.

Donation Enclosed: *
Surname Name: *
First Name: *
Street Address: *
Address Line 2:
City & Postal Code: *
Home Phone: *
Mobile Number:
Email address: *
Do you require a receipt ?	Please note that a receipt for online payment may take 2-3 weeks.

HAVE YOU MADE YOUR ONLINE PAYMENT?

(The above information is for the Trusts use only and will not be sold or given to any other individual or organisation)

THANK YOU FOR YOUR SUPPORT