Orange Regional Gallery Extension - Fund Raising Campaign

Donation Form - gifts of $2 or more are tax deductable

Donation amount (required)

$10 - $100,000

Name

Title

First name

Middle name

Last name

Address

Address Line 1

Address Line 2

Suburb

State

Postcode

Country

Email (required)

Phone number

Area

Phone Number

I wish to be acknowledged on the Donor’s board ($3,000 and above) as:

I wish to receive information updates about the Orange Regional Gallery Project

I wish to remain anonymous

The Orange Regional Gallery has deductable gift recipient (DGR) status with the Australia Taxation Office (ATO).
ABN: 85 985 402 386