Make a Donation to Diabetes Tasmania

If you have any questions about how we use your personal information please read our Privacy Policy. Please note that the * indicates a mandatory field. If you would prefer to make an anonymous donation to Diabetes Tasmania, you may choose to send a cheque or money order made payable to Diabetes Tasmania and dropped into our offices at either 88 Bathurst Street, Hobart or 64 Cameron Street, Launceston. Donations sent by mail should be addressed to Diabetes Tasmania, GPO Box 827, Hobart TAS 7001.

Thank you for you Support.

Title	*
First Name	*
Last Name	*
Organisation Name
Gender
Date of Birth	(dd/mm/yyyy)
Postal Address	*
City	*
Postcode	*
State	*
Daytime Phone	*
Mobile Phone
Email
Diabetes Type	*
Donation Purpose
Donation Amount ($)	* (enter numbers only ex:10,20)
If you’re making this gift to honour the memory of a loved one please indicate their name in the space below.
In Memory of the Late

© 2010 Diabetes Tasmania. Diabetes Australia - Tasmania trading as Diabetes Tasmania ABN 90 087 092 180.
88 Bathurst Street, Hobart TAS 7000. Phone 03 6215 9000, Fax: 03 6215 9099. For all information regarding our
refunds policy please contact us on 1300 136 588 Monday to Friday 9.00am to 5.00pm, closed Public Holidays.