Commemorative 500 Club Donation Form

I would like to make a donation of $500.00 to Christchurch Memorial RSA Commemorative 500 Club to assist with the rebuild of Christchurch Memorial RSA in return for the acknowledgement of the loyal service and sacrifice of the NZ Defence Forces member whose details are shown below to be inscribed on the Christchurch Memorial RSA Remembrance Wall.

Donor Name:

Email:

Phone:

Address:

Relationship to Veteran:

Veteran's Name:

Service Number:

Service / Unit :

Period Served:

Where Served:

Age or Date of Death:

I / We plan to make this contribution in the form of:

Online by Credit Card Bank Deposit, Cheque or Cash

A tax receipt will be issued once we have recieved your donation. Please include your name or email as an identifier if paying by direct debit.

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