Early Education (EarlyEd) Inc.
ABN: 42 096 307 200

Yes! I will help make a difference to the lives of children with disabilities.

Name: ________________________________________________________________________

Address:_______________________________________________________________________

______________________________________________________________ Post code:

Phone: E-mail:

I wish to make a tax-deductible donation:

r $80 - Fees for a family to attend EarlyEd for a term

r $160 - Fees for 2 families to attend EarlyEd for a term

r $320 - Fees for a family to attend EarlyEd for a year

r $500 will provide resources such as switch operated toys

r $1000 will provide valuable resources and specialist equipment

r Other

ri I would like to make this amount a monthly donation to be charged to my credit card

Payment options:

· Cheque or money order payable to: Early Education (EarlyEd) Inc. OR

· Credit card. Please provide your details below

Cardnumber:rrrr rrrr rrrr rrrr

Cardholder name:

r Visa r MasterCard Expiry date: rr / rr

Amount donated: $_________________________ Signature:

Please post this form to: EarlyEd

19/248 Miller St,

North Sydney, 2060

or fax to: (02) 9923 2728