Print the form and fax or mail your subscription or donation

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Print the form and fax or mail your subscription or donation (see below).

Donations over $2 are tax deductible.
The purpose of the Lead Education and Abatement Fund (L.E.A.F.) is to support the environmental objects of The LEAD Group Incorporated, that is to protect the environment from lead.

Please accept my membership application and/or donation:

$5.00 annual membership (non-corporate rate)

$132.00 annual membership (corporate rate)

PAYMENT DETAILS:

Please find enclosed my cheque / money order for $________payable to:
"The LEAD Group" being for membership

Please find enclosed my cheque / money order for $________ payable to:
"LEAF" (Lead Education and Abatement Fund) being for a donation

Please charge the amount of $____________
to my |__| Visa Card |__|Master Card (tick one)
payable to "The LEAD Group" being for membership

Please charge the amount of $____________
to my |__| Visa Card |__|Master Card (tick one) payable to:
"LEAF" (Lead Education and Abatement Fund) being for a donation

Please Print & Mail form & payment to:
The LEAD Group Inc.
PO Box 161
Summer Hill NSW 2130 Australia
OR fax the form to:
+61 2 9716 9005
OR phone us with your credit card details on:
+61 2 9716 0966
Freecall 1800 626 086
(Australia only)

Name on Card:___________________________________________________________________

Signature ________________________________________

CARD NO. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiry date: _____ / _____

Card verification code: |__|__|__| look on the back of the card for a 3 digit code on the signature strip. It will be either after the full customer account number or after the last 4 digits of the customer account number

CONTACT DETAILS:
Name or Company Name (for corporate subscriptions):

__________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________

Phone:___________________ Fax/email: ________________________

The LEAD Group [ABN 25 819 463 114] Inc is endorsed as an Income Tax Exempt Charitable entity under subdivision 50-B of the Income Tax Assessment Act 1997. The Lead Education and Abatement Fund (L.E.A.F) is a public fund listed on the Register of Environmental Organisations under Item 6.1.1 of subsection 30-55(1) of the Income Tax Assessment Act 1997 and is endorsed as a Deductible Gift Recipient under subdivision 30-BA of the Income Tax Assessment Act 1997.

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