Name_____________________________Phone (H)_______________Phone(W)_______________ FAX(H)_________________ FAX(W)_________________ Address:________________________________________________________________________ ______________________________________________________Post Code_________________ Do you have any special talents/skills that will help the movement (fundraising, typing, corporate contacts, media contacts, election campaign experience?) ________________________________________________________________________________ Please make cheques payable to Pauline Hanson's ONE NATION or charge my credit card: Bankcard Visa Mastercard AMEX Diners Amount $_______________ Number_________________________ Expiry Date____________ Name of Card Holder_____________________________Signature______________________ or enclose cheque made out to: Pauline Hanson's One Nation A receipt will be given for all donations made and your donation will be added to the on-line target.