Dolphin Research Institute (DRI)

Adopt-A-Dolphin Form - thank you for joining us

We value your support for our work. Adopt-A-Dolphin, for yourself or as a gift, is easy - just complete all required (*) fields and any other relevant fields below.


Application to become an Adopt-A-Dolphin Member of the Institute, or to give an Adopt-A-Dolphin as a gift.
 (In Australia AUD$98 or Overseas AUD$125 for 1 year)

Please select Adopt-A-Dolphin type
$10 (GST included) is treated as membership subscription, the balance is a tax deductible donation (in Australia)
  AUD$98 - Australia
 AUD$125 - Overseas (applies if Adopt-A-Dolphin recipient's address is outside Australia)

I will also make a donation to support the Dolphin Research Institute's research and education programs

 AUD$ donation  (tax deductible donation in Australia)
              (insert amount in whole $dollars only)

Payer's Details: (Your own details) *=Required details, even if the Adopt-A-Dolphin is a gift for someone else.

 

If this Adopt-A-Dolphin is for you, your full name will appear on the Adopt-A-Dolphin Certificate. If you want a special date on your certificate, indicate date below.
* First Name:
* Surname:     Age:   years  (helps us tailor Adopt package contents to your age group)
* E-mail Address (for receipt):
   Home Phone: Business Phone:
* Postal Address:
* State:
* Post Code:
* Country:
Please email me about:
New products/specials Yes  No thanks  
DRI Events Yes  No  
Volunteering Yes  No  

I would be happy to have my name published as a supporter, in the Newsletter. Yes No

 

 

Is this Adopt-A-Dolphin a gift for someone other than the card holder?     Yes     No

   - If "No", please select "Submit Form" at the bottom of this page, to proceed to our secure payment transaction page. You can pay by Visa or Mastercard.

   - If "Yes", please provide the gift recipient's details in the next section (* required).


Details of the person receiving this gift Adopt-A-Dolphin (name will appear on the Adopt-A-Dolphin Certificate)

If Adopt-A-Dolphin is a gift please complete this section - (* required)
* First Name:
* Surname:     Age: years (helps us tailor gift Adopt-A-Dolphin package contents to your gift recipient's age group)
   E-mail Address:
   Home Number:
   Business Number:
* Postal Address:
* State:
* Postal Code:
* Country:
For a special date (e.g. birthday) on the certificate,
indicate date (as dd/mm/yyyy)   / /
* Where is the initial package to be sent?    To the Payer     To the gift recipient
* Where is the annual
Adopt-A-Dolphin renewal to be sent?    To the Payer     To the gift recipient

How did you hear about the Institute and Adopt-A Dolphin?   


You've almost secured your very own Adopt-A-Dolphin. Just a few more steps to complete your adoption...

Step 1. Please check the information you've provided and that all *required fields have been completed
Step 2. Select "Submit Form" at the bottom of this page (read step 3 and 4 first!)
Step 3. On the next page, National Australia Bank's secure payment page, enter your Visa or Mastercard information and select Authorise Payment
Step 4. You will then see your printable online receipt and transaction details. You'll also receive a confirmation receipt by email.

Please note that all payment amounts are in Australian Dollars. For payments made from outside Australia, your credit card provider will convert the total amount of your order to your own currency equivalent and may charge you an additional fee for an international currency transaction. Please allow 2 weeks for delivery within Australia or 3-4 weeks for delivery to an overseas address.

 

        

©Dolphin Research Institute, 2009