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DEFEAT MSA NEW ZEALAND TRUST

Defeat Multiple System Atrophy New Zealand Trust
P O Box 125238, St Heliers, Auckland, 1740

Donation Amount
Choose your donation amount?*
- $35
- $50
- $75
- $100
- $250
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- $5000
- Other
Amount*
Donation Frequency*
Recurring donations are the best way to support our efforts to Defeat MSA!
- One Time
- Monthly
- Quarterly
- Annually
Contact Information
Name*
First Last
Phone Number*
Email*
Billing Information
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Payment Information
Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$ 0.00
DO YOU WANT TO DEDICATE YOUR DONATION TO SOMEONE? (IF SO, RESPOND BELOW)
DO YOU WANT TO DEDICATE YOUR DONATION TO SOMEONE?
- Yes
- No
Choose
- In Honor of
- In Memory of
- In Tribute to
Name
First Middle Last
- Please send an acknowledgement to the individual or family for whom this donation is dedicated
How do you want to send acknowledgment?
- Send Email acknowledgement
- Send Postal Mail acknowledgement
By you sending a confirmation to the family that you have donated in honor of their loved one saves us the extra time, printing and postal charges. We can help you send this confirmation by emailing you an acknowledgment along with your donation receipt so that you can print it off and send it to the family of the person you are honoring. If you still wish us to send an acknowledgement letter by snail mail, please email us at: director@www.msadownunder.org.au
Name*
First Last
Email*

Acknowledgement will send to this email.
Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dedication message
Do you wish your donation to be targeted to a specific legacy fund?
- Siong-Chi-Lin
- Joseph Fortier
- Mike Boylan Sr
- Debbie Graham
- Raymond Massaccesi
- Douglas Bettenhausen
- Rey Umali
- Charlene Soleau
- Susana Schnarndorf
- Denise Rae Cryderman-Williams
- Debra Pinkston
How would you like your donation to be used?
How are you connected to multiple system atrophy?
pick one answer that best fits you
Giving Options
Your donation is securely processed. However, a 3% charge is added by our bank for a transaction fee. Please consider chipping in an additional 3% so 100% of your donation amount goes to us.
- Donate 100% - Add 3% so that 100% of the donation goes to DEFEAT MSA!
- Use 3% of my donation to cover banking fees.
- Join our Newsletter

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DEFEAT MSA NEW ZEALAND TRUST

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