Donation Form - Around Australia Challenge Wheelchairs for Kids

Yes! I would like to make a donation to
The Around Australia Challenge
The solo sail by Mike Rowney, paraplegic mariner,
to help buy wheelchairs for kids in 3rd world countries.

My name: ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

My address (for receipt): ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

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Phone number: ЕЕЕЕЕЕЕЕЕЕЕЕЕЕ Email: ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

Amount of donation: AUD $ ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ

Method of payment: Cheque (enclosed) ЕЕЕЕЕЕ Other ЕЕЕЕЕЕ

Signature ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ Date ЕЕЕЕЕЕЕЕЕ

If you would like to send a personal message of support to Mike as he sails around Australia, please include it below!

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Please complete this form and post it with your donation to Around Australia Trust Account, c/o Wheelchairs for Kids, P.O. Box 64, Onslow WA 6710, Australia

THANK YOU!