Pukaha Mount Bruce fax or mail sponsorship order form

Your name              ___________________________________________
Your address           ___________________________________________
                            ___________________________________________
                            ___________________________________________

No. hectares sponsored ____(A)    No. of years ____(B)
Sponsorship amount @ $25/hectare/year ($25 x A x B) = $____________
(e.g. 1 hectare for 3 years = $25 x 1 x 3 = $75)

No. of CDs ____(N)
Purchase amount @ $39.95 (incl. GST )/CD ($39.95 x N) = $____________

                                                                    Total = $____________

Payment method: Cheque (Pay to National Wildlife Centre Trust)     ____
(tick one)             Credit card - MasterCard/Visa                         ____

Number on credit card:                                     - - - - / - - - - / - - - - / - - - -
Expiry date                                                                                      - - / - -

Name on credit card                           _____________________________

                  Signature                          _____________________________

A special gift for a friend

Sponsoring a hectare as a gift for a friend is also a very special way of
celebrating our future together.Your friend will receive a gift certificate
and information about the Pukaha Mount Bruce restoration.

Name of Friend ___________________________________________
Address of Friend _________________________________________
________________________________________________________
________________________________________________________

Complete the credit card details on this form and fax to (06) 375 8003
or
Complete this form and send with cheque to