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$50 25 $150 y cheque is enclosed made payable to the Neurological Foundation would like to become a member of the Neurological Foundation for $5 per year e by internet banking: ANZ Auckland 06 0287 0133301 07 enter your initials, name and this reference ID: umber: on Card: Signature: ease send me information about leaving a bequest. ease take my name off your mailing list. ould like to give $ each month. ease send me an automatic payment form OR debit my credit card above each month eceive receipts via email dividually or annually) $75 Date: nk you for your generous support Other $