| Appeal Name: | Gay and Lesbian Rights Lobby Appeal | |
| Organisation Name: | Victorian Gay and Lesbian Rights Lobby | |
| Address: |
PO Box 2156 FITZROY BC VIC 3065 |
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| Fax: | ||
| Phone: | 0417 484 438 |
Print out the donation application below
- Send to your chosen organisation with your credit card details, cheque
or money order
- or Fax to your chosen organisation with your credit card details.
| Title: | First Name: | Last Name | |||||
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| Phone (H): | Phone (w): | ||||||
| Fax: | Email: | ||||||
| I would like to donate | $ | to Victorian Gay and Lesbian Rights Lobby | |||||||||||||||||||
| Enclosed is my cheque/money order | |||||||||||||||||||||
| Please charge my credit card | |||||||||||||||||||||
| Credit Card Details | |||||||||||||||||||||
| Card Type: | Visa Mastercard Bankcard AMEX | ||||||||||||||||||||
| Card Number: |
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| Expiry Date: | ____/____ | ||||||||||||||||||||
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| Date of Order: | ____/____/____ | ||||||||||||||||||||
  Preferred
Community Card for Australia |
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