Gift Donations, Wallcharts and Videos Ordering Form

From:
Name: ______________________________________
Address ____________________________________
____________________________________________
____________________________________________
_______________________Postcode _____________
Daytime Tel number: __________________________
Email (Optional ): _______________________________

Gift Recipient/s Address for Newsletters next year:
Name: ______________________________________
Address _____________________________________
____________________________________________
____________________________________________
_______________________Postcode _____________

Email (Optional ): _______________________________

If you are making more than one gift donation, please attach additional addresses on a separate sheet.

DONATIONS	COST	HOW MANY	AMOUNT
Patagonia Steppe Wilderness	£25/Saves an acre
Fundaçion Jocotoco (Ecuador)	£25/Saves an acre
Amazon Basin Rainforest Fund	£25/Saves an acre
Friends of Belize	£20/a Year
Danjugan Island Support Fund	N/A
WLT Action Fund (for most urgent needs)	N/A
			Sub Total
WALLCHARTS (rolled in tube)	COST (inc P&P)	QUANTITY	AMOUNT
Danjugan Island Wall Chart	£1.25
Costa Rica Wall Chart	£1.25
Or both Wall Charts.	£2.00
			Sub Total
NEW WLT VIDEO	COST (inc P&P)	QUANTITY	AMOUNT
Danjugan Island - A Limited Edition	£9.00 each (inc P&P)
Programme For Belize	£9.00 each (inc P&P)
			SubTotal
PAYMENT
[ ] I enclose a cheque/PO: [ ] Please debit my credit card:			Grand Total	£______

Credit Cards: Access / Visa / MasterCard / Charity Card

Card number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiry date: ___/___

Cardholder's name: _________________________________________
Signature : _______________________________ Date: ____________

If your donation is a gift, please complete the information below

[ ] YES, my donation is a gift.
My gift recipient/s (as well as myself) would also like to receive WLT News (at above addresses). YES/NO^*
*delete as appropriate and if YES, complete the Gift Recipient box at the top of this form.

[ ] I would like a Standard certificate bearing my gift recipient's name only, and would like the name to appear on the certicate as: _______________________________________

[ ] I would like a Gift certificate with my/our name on, and my gift recipient's name/s as follows:
Person/s making donation: ______________________________________________
on behalf of: _________________________________________________________

Gift packages (which include certificate, greeting card for your message, current issue of WLT News, and project information are sent to you, to pass on unless you state otherwise.