Septic Shock Clinical Research Fund
Donations of $2 or more to the Masonic Foundation,
on behalf of the SSCR Fund, are tax deductible.
Please accept my donation of $________ to the Masonic Foundation
on behalf of Lodge Foelsche's SSCR Fund.Payment options (Please circle one) Visa Mastercard Bankcard American Express Card Number _______ _______ ________ _______ Expiry Date ___/___ Name on Card ________________________________ Cheque (Payable to the Masonic Foundation) Details for receipt Name ________________________________ Address ________________________________ Suburb ________________________________ State __________________ Postcode _______ Please print this form and fill it out.
Then post it to:The Masonic Foundation,
2/262 Grange Road,
Flinders Park, SA 5025.Credit card donation details can be e-mailed to the Masonic Foundation.
© Lodge Foelsche, No 211 SA&NT.