ANZMES Supporter Form

Supporter Type information costs -

- Supporter - Giving Amount
Per Year $10.00 (digital edition of M.E. Time magazine)

- Community Supporter - Giving Amount
Per Year $45.00 (option of digital or printed edition of M.E. Time magazine)

- Representation Supporter - Giving Amount
Per Year $75.00 (option of digital or printed edition of M.E. Time magazine)

- Education Supporter - Giving Amount
Per Year $150.00 (option of digital or printed edition of M.E. Time magazine)

- Research Supporter - Giving Amount
Per Year $250.00 (option of digital or printed edition of M.E. Time magazine)

- Sector Supporter - Giving Amount
Per Year $350.00 (option of digital or printed edition of M.E. Time magazine)

- Sustaining Supporter - Giving Amount
Per Year $450.00+ (option of digital or printed edition of M.E. Time magazine)

Please note: all personal details will be kept strictly confidential.

Persons name *

Title

First name

Last name

Persons address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Email address

Telephone number

Date Joined

Gender Identity *

Date of Birth

Supporter Type

Previous Membership number (if renewing supporter type)

M.E. Time Magazine distribution options (Please note: The Supporter tier only receives a digital edition of M.E. Time magazine) *

Supporter Tier Amounts *

$10.00 Supporter option
$45.00 Community option
$75.00 Representation option
$150.00 Education option
$250.00 Research option
$350.00 Sector option
$450.00 Sustaining option
$0.00 Helping Hands option
Other
$

Donation Amount Note: Your donation is fully tax deductible.

No Donation $0.00
$10.00
$20.00
$50.00
$100.00
Other
$

Recurring period

This information is for people making recurring payments to ANZMES

First payment date

This information is for people making recurring payments to ANZMES

Last payment date

This information is for people making recurring payments to ANZMES

Please let us know if you have a particular area that you would like your donation to go towards.

Payment method *

If paying by cash please attach contact details and send to;
ANZMES,
43 Princes Street, Dunedin Central, Dunedin 9016.

If paying by direct transfer to ANZMES Bank account -
ANZMES
01 - 0414 - 0276330 - 00

Stripe - Credit & Debit Cards

Cash Payment
If making a cash payment, please send to -

ANZMES,
43 Princes Street, Dunedin Central, Dunedin, 9016

Direct Transfer to Bank Account
Internet Bank Payment

Payment already made through Stripe link
Stripe Payment

Pay processing fee

We are charged a small fee for processing online payments.

Total amount