LITHGOW  SMALL  ARMS  MUSEUM  INC.

Donation / Pledge Form

Please complete this form and post to:
Lithgow Small Arms Museum Inc.
P.O. Box 564
LITHGOW, NSW 2790
AUSTRALIA

I / We hereby wish to make the following gift or pledge towards the purchase of the museum building at Methven St., Lithgow, N.S.W.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone:    (. . . . . . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I / We wish to make a gift of AUD$ . . . . . . . . . . . . . . . . . .

__ A cheque made payable to the Lithgow Small Arms Museum is enclosed.

       or

__ Please debit my Credit Card:  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ 

     Cardholder name  . . . . . . . . . . . . . . . . . . . .   exp date:      /        Signed  . . . . . . . . . . . . . . . 

       or

__ I /We wish to pledge the amount of $ . . . . . . . . . .   We understand this pledge to be redeemed when the Museum Committee considers it has sufficient funds to invest towards its future bid for ownership.

       Signed  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All donations to the Museum of more than $2 are tax deductible in Australia and its Territories