Thank you for your Donation

Thank you for your Donation

Your contribution is what keeps our efforts alive in ensuring the New Zealand Tuberous Sclerosis Complex community are informed, connected and supported.
Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City / Town

Postal / Zip Code Country
Email *
example@example.com
Date *

Day Month Year
Date

My Donation (Credit/Debit Card)

Donate $ 200 NZD

Donate $ 150 NZD

Donate $ 100 NZD

Donate $ 50 NZD

Donate $ 30 NZD

Custom Amount $ 10 NZD

Quantity
Item subtotal: $ 0.00 NZD

OR My Donation (Online banking) Please complete the amount you would like to donate and we will email you the bank account details.
What is your connection to TSC?

I am an individual with TSC I am a relative of an individual with TSC I am a medical practitioner Other
Join our mailing list? *

Yes, please add my email address above to your mailing list No thanks or I am already
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