SPONSOR A PIPE:  (General/Violin Diapason/Cornopean)

Please Complete and Return To:

The Treasurer,
St Jude's Music Association,
34 Bendooley Street,
Bowral, NSW, Australia 2576

I wish to sponsor     Organ Pipe(s).

Title: Initials: Surname:  
Address:
 
  State: Post Code:
Telephone:
E-mail:  

I wish to pay as follows:

  Full payment of ($300 per pipe / $450 for VD / $600 for Cornopean)

  Three payments of ($100 / $150 / $200 per pipe),  payments made in

  I enclose cheque (Payable to "St Jude's Music Association Public Fund".)

  Please debit my    Mastercard;    Visa

Number:  

Expiry Date:  


Signature:    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Please complete the details above, then using the Print Button, print this form. Then sign and post it to the address shown.