BLACKHEATH GOLF & COMMUNITY CLUB
PROPOSED EXTENSION TO EXISTING TERRACE
House Improvement Fund
(of the Blackheath Golf Club Foundation)
Tax Deductible Donation Form
$250 BRONZE
$1,000 SILVER
$5,000 GOLD
$10,000 PLATINUM
OTHER: $
Pay in one lump sum
Pay in 2 annual instalment payments of $_______
Pay in 3 annual instalment payments of $_______
Pay in 5 annual instalment payments of $_______
Amount of contribution:
Commencing this financial year, I wish to support the Blackheath GC Foundation’s House Improvement Fund:
BRONZE
$250
GOLD
$5,000
SILVER
$1,000
PLATINUM
$10,000
Payment details:
Cheque - made payable to ‘Australian Sports Foundation Ltd’
Direct Deposit - Transfer description must include your name and “209130” | BSB: 032-776 | Account N
o
: 130159 | Account Name: ASF Donations Account
Credit Card:
Mastercard
Visa
Amex
Other
Card Number
Expiry Date CCV
Card Holder’s Name
Signature
I would like my gift to benefit The Blackheath Golf Club Foundation and I understand that my donation is made unconditionally to the Australian Sports Foundation.
By making this donation I accept the ASF’s Privacy Policy and Terms and Conditions.
Please return this form to:
Mr RB Tubbs
BG&CC Board Member
PO Box 103, Katoomba NSW 2780
r.tubbs@sport.usyd.edu.au
0402 003 042
The Blackheath Golf Club Foundation is registered with and conducted under the charter of the Australian Sports Foundation Ltd (ABN 27 008 613 858).
The Sports Foundation’s Privacy Policy explains how it collects, uses, stores and discloses your personal information, and is available at asf.org.au/about/privacy-policy.
Details of donation Terms and Conditions are available at asf.org.au/about/ terms-conditions.
Personal details:
Title
Dr
Mr
Mrs
Ms
Miss
Other _____________
Name
Company Name
Address Postcode
Mobile Other Phone
Email*
(if required on receipt)
* Your receipt will be emailed to you, please ensure
you include a valid email address
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