Title:  Mr  Ms  Mrs  Miss  Dr  Other

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General Sport Division – Rugby League

Personal details

Title:  Mr  Ms  Mrs  Miss  Dr  Other

First name/s: Last Name:

Mailing Address:________________________________________________________________________________________

Town/Suburb: State: Post Code:

Country: Phone Home: ( )

Phone Business: ( ) Email:

Gift details
Please accept my one-off gift of $
Please accept my MONTHLY gift of $ on the 10th of every month commencing on 10 / /13
Please accept my QUARTERLY gift of $ commencing on 10 / /13
Please accept my ANNUAL gift of $ commencing on 10 / /13
and continue until I notify you otherwise in writing. Gifts of $2 or more are tax deductible

Please direct my gift to: Sydney Uni Rugby League Club

Payment details

 Cheque (make payable to The University of Sydney)
Credit Card:  Visa  MasterCard  American Express  Diners Club

Card No:

Expiry Date: Card Holder Name:


 I would like my gift to remain anonymous

 Please send me information regarding the University Bequest Program

Thank you for your generous support

Please return this form to: Advancement Services, G02 – Jane Foss Russell Building,

The University of Sydney, NSW 2006 Australia,

fax 61 2 8627 8819

ABN: 15211513464 Charitable Fundraising No: 10369 CRICOS 00026A

CODE: 2400 47301 D0907 P 09/13
PRIVACY ASSURANCE: The information you provide on this form is collected by the University of Sydney to maintain contact and keep you up-to-date with information about the University, its services, events and achievements. It may be passed on to groups affiliated with the University, such as alumni organisations and foundations (local and overseas), SU Sport and residential colleges. Your name may be published in the annual honour roll. If you wish to remain anonymous or do not wish to receive information, please contact Advancement Services (fax 8627 8819, or email alumni.updates@sydney.edu.au).The University abides by the “NSW Privacy and Personal Information Protection Act".

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