Thank you for donating to CCSM New Zealand. Please complete this form so we know where you would like your donation allocated and so we can send you a receipt. It is important that your reference details below match the details on your cheque/transfer/deposit.
Full Name
Email
Phone
Donation Amount:
What Reference details did you include with the donation?
Choose the area to which you would like the donation to go:
Is a receipt required?
Address 1
Address 2
Suburb
City/Region
Post Code
Country
Anything you would like to add?