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Use this form for donations via 
 - electronic funds transfer to the PMS Museum Assoc Inc bank account. BSB 302 162   Acct: 126455-6.  OR
 - credit card.  Card details are not retained on the website.

For payment by cheque close this form and select Donation by Mail form

Family Name Now: *

Given Names: *

Preferred Name: *

Title (eg. Mr, Dr): *

Postal Address Line 1: *

Postal Address Line 2:

Town/Suburb: *

Post Code:

Country

Home Phone:

Work Phone:

Mobile Phone:

Email Address:

Amount Donated *

Select Method of Payment

Credit Card Number

Expiry Date

Security Number

Cardholder's Name