Your Seat in Yarra's History - 2 Months Donation

TAKE YOUR SEAT IN YARRA'S HISTORY

Two Equal Monthly Donations Form

Personal Details
Payment Details

Plaque inscription options:

Option A: Individual family member naming

OPTION A: Individual family member naming:There is room on each plaque for up to 3 people. If you have more than 3 people that you would like to acknowledge, please contact the Development Office on E: development@yvg.vic.edu.au Please note, the location of your seat plaque will be determined by receipt of payment date. Seating at events in the chair that bears your name is not guaranteed. Maximum of 20 characters only. First name and Last name combined

Option B: Family naming

Please note, the location of your seat plaque will be determined by receipt of payment date. Seating at events in the chair that bears your name is not guaranteed.

Plaque 1 - Please engrave our plaque with this inscription

Option A: Individual family member naming

Option B: Family naming

First Name

Last Name

Year

First Name

Last Name

Year

First Name

Last Name

Year

Family Name

Plaque 2 - Please engrave our plaque with this inscription

Option A: Individual family member naming

Option B: Family naming

First Name

Last Name

Year

First Name

Last name

Year

First Name

Last Name

Year

Family Name

Plaque 3 - Please engrave our plaque with this inscription

Option A: Individual family member naming

Option B: Family naming

First Name

Last Name

Year

First Name

Last Name

Year

First Name

Last Name

Year

Family Name

Total payable for plaques: $

Total Donation: $. This will be charged to your credit card in two equal payments, one processed today and one that will be processed in one month鈥檚 time.

First payment (today): $ Second payment (in one month鈥檚 time): $