Online Donation

I would like to make a single donation from my credit card.

Choose Amount

$10

$20

$50

$100

Donation Amount ($NZD) *

Invoice Number *

Your Details

Title

First Name

Last Name

Name to appear on Tax Receipt: (if different from above)

Address:

Suburb:

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Message (Optional):

Yes, please add me to the mailing list to keep me up to date with news from Dementia Canterbury

Yes

Email *

Note:

After form completion you will be redirected a secure (256 bit) Payment Express (DPS) hosted payment payment page. Your credit card details will be taken and processed there before redirecting back to the current website (hosted at Umbrellar - New Zealand).

Both Visa and Mastercards are accepted.