Belarus & Baltics   
I would like to become a 'Young Life Belarus & Baltics' Partner
Post to: Young Life, PO Box 240, West Ryde NSW, 1685 Phone: 1300 557 647 Fax: (02) 9877 5155
Your Donation
  $ 50
  $ 75
  $ 100
  $ 150
I would like to donate this amount to Young Life
  each month
  as once off contribution
Donations to Young Life are tax deductible
Your Details
Please add me to your donor mailing list for future updates
Payment Method
Please debit my Credit Card
Visa Bankcard Mastercard diners Amex  
Card no.
Name on Card Expiry Date
Signature ______________________________  
Cheque / Money Order
I enclose a cheque / money order (made payable to Young Life Australia)
Direct Debit Payment
Financial Institution name  
Account name First Payment
BSB no.
Account no.
Direct Debit Request: I / we authorise Young Life Australia (APCA User ID No 068 015) to arrange for funds to be debited, through the Bulk Electronic Clearing System (BECS) from my/our account at the financial institution identified above and as prescribed above. This authorisation is to remain in force in accordance with the terms described in the Young Life Direct Debit Service Agreement .

Direct Debit Request Service Agreement: These are the arrangements on which this agreement to direct debit your account are made. 1. You will be given 14 days notice of any changes to the Direct Debit arrangements. 2. For all matters relating to the Direct Debit arrangements, such as stopping, deferring or altering these arrangements, please call Young Life on (02) 9877 5155; or contact the staff member in your area; or write to The Director, Young Life, PO Box 240, West Ryde NSW 1685; and allow 14 days for any alterations to take effect. 3. You should be aware that Direct Debiting through the Bulk Electronic Clearing System (BECS) is not available on all accounts; and account details should be checked against a recent statement from your financial institution. If you are in any doubt you should check with your financial institution before completing the Direct Debit Request. 4. It is your responsibility to ensure there are enough funds in the account you nominate for direct debiting to make payments. 5. If the due date for payment falls on a non-working day or public holiday, the payment will be processed on the day after. If you are in any doubt please contact Young Life as described in Point 2 above. 6. For any returned or unpaid transactions Young Life will not be responsible for any fees and charges incurred. 7. All customer records and account details will be kept private and confidential to be disclosed only at your request or at the request of a financial institution in connection with a claim being made to an alleged incorrect or wrongful debit.

Signature ______________________________ Date
Signature ______________________________ Date