Melbourne Vixens Donation Request Form

Organisation Name*

Organisation Type*

Netball Victoria affiliated association Netball club Not-for-profit organisation Charitable event

Other:

Reason for Request*

Item/s Requested*

Signed memorabilia Show bags

Other:

Quantity Requested*

Event Name & Date (if applicable)

Name*

First Name

Last Name

Email*

Phone*

Address*

Address Line 1

Address Line 2

City

State

Postcode

Are you a Netball Victoria member?*

Yes No

Membership Number (if applicable)

Are you a Melbourne Vixens member?*

Yes No

Membership Number (if applicable)

PLEASE NOTE

1. Completion of this form is a request only and does not guarantee a donation.

2. If successful the applicant is responsible for any associated postage costs.