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Magen David Adom

Supporting Magen David Adom in Saving Lives

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NSW Membership

2019 Membership Form

Membership
Membership opportunities for 2019 calendar year
- Family Membership (includes dependent children) - $95.00
- Individual membership - $65.00
- Student membership (25 years and under) - $35.00
- Gold patron $5000 (Includes $95 Membership. Balance is Tax Deductible)
- Silver Patron $2500 (Includes $95 Membership. Balance is Tax Deductible)
- Bronze Patron $1000 (Includes $95 Membership. Balance is Tax Deductible)
I would like to add a TAX DEDUCTIBLE donation
Total
$ 0.00
Family Name
Name*
First Last
Family Members
First Name
Email
Home/Mobile Phone*
Address*
Street Address Address Line 2 Suburb State Postcode
Payment Method*
- American Express
- Visa
- Mastercard
- Other
Card Number*
Expiry Month*
Expiry Year*
Security Code*
Cardholder Name*
Credit Card*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
OTHER PAYMENT OPTIONS
EFT (Note new bank account details)
Account Name: Australian Friends of Magen David Adom Limited
BSB: 062 124
Account: 1138 9713.

To ensure your payment is correctly acknowledged, please quote your MDA member number and full name when depositing funds.

CHEQUE
Mail to PO Box 293, Edgecliff NSW 2027 and quote your MDA member number

CALL (02) 9358 2521

Thank you for your support

Australian Friends of Magen David Adom Limited
PO Box 293 Edgecliff NSW 2027
Tel: (02) 9358 2521 Fax: (02) 9358 3893

The MDA ambulances and MICU medical teams provide emergency medical treatment to over 679,000 people a year

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