OPERA QUEENSLAND DONATION FORM Title: ______ First name: __________________ Last name: ___________________________________ Title: ______ First name: __________________ Last name: ___________________________________ Address: ______________________________________________________________________________ Suburb: _____________ State: ______________Postcode: ___________________________________ Daytime Telephone: ______________________Mobile: _____________________________________ Email: ________________________________________________________________________________ Please let us know if any details have changed. Update your details in the space below. I would like to make a tax deductible donation to my opera company. Donation amount: _____________ PAYMENT OPTIONS Please find enclosed my cheque made payable to Opera Queensland Ltd I have transferred the amount above to Opera Queensland’s bank account using this reference: ______________________________________ (Please use your last name as a reference where possible) BSB: 034-013 Account Number: 571115 Account Name: Opera Queensland Ltd Donations Fund Charge my credit card the amount of $_______________ Visa or Mastercard Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry _ _ / _ _ Cardholder name: ____________________________________________________ Signature: ____________________________________________________ Date:__________/__________/___________ Opera Queensland recognises donations of $500 and above in our Patrons Program, website and annual report. Please indicate how you would like your name to appear: _______________________________________________________________________________________ OR I wish to remain anonymous Please return this form to Opera Queensland, PO Box 3677, South Brisbane QLD 4101