            !!PLEASE HELP KEEP THE FLYING DOCTORS FLYING!!
  Please enclose your Cheque or Money Order together with this Donation
  Form, or fill-in the Credit Card information below, and post all to:

              ROYAL FLYING DOCTOR SERVICE OF AUSTRALIA
              PO Box 385
              Kent Town 5071
              South Australia
              Australia

  Donations of $A2 or more are tax deductible.  Receipts will be issued
  for all donations.  Overseas donations are requested by Credit Card
  or Money Order or Bank Cheque, denominated in Australian Currency.
 |**********************************************************************|
 | FOR ALL DONATIONS - Name and Address of Donator                      |
 |                                                                      |
 | Name:   ____________________________________________________________ |
 |                                                                      |
 | Address:____________________________________________________________ |
 |                                                                      |
 |         ____________________________________________________________ |
 |                                                                      |
 | City:   ____________________________________________________________ |
 |                                                                      |
 | State/Province:  ___________________________________________________ |
 |                                                                      |
 | Postal/ZIP Code: ______________   Country:__________________________ |
 |**********************************************************************|
 | FOR ALL DONATIONS - Amount and Method of Donation                    |
 |                                                                      |
 | DONATION AMOUNT:  Dollars Australian ($A)___________________________ |
 |                                                                      |
 | METHOD OF DONATION (please circle one):                              |
 |                                                                      |
 |  Personal Cheque  /  Bank Cheque  /  Money Order  /  Credit Card     |
 |                                                                      |
 |**********************************************************************|
 | FOR CREDIT CARD DONATIONS ONLY (please circle one):                  |
 | Please debit my (please circle one):                                 |
 |                                                                      |
 |   VISA   /   Mastercard   /   American Express   /   Diners Club     |
 |                                                                      |
 | Credit Card number: ________________________________________________ |
 |                                                                      |
 | Expiry Date:        ________________________________________________ |
 |                                                                      |
 | Signature:          ________________________________________________ |
 |**********************************************************************|
 | FOR ALL DONATIONS - OzPack state scenery: (please circle one)        |
 |                                                                      |
 |     NSW       NT       QLD       SA       TAS       VIC       WA     |
 |                                                                      |
 |**********************************************************************|
                                                        RFDS code: OZPACK


