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			Yes, I want to reduce the incidence and improve the treatment of neurological disorders. I am interested in sending a regular donation direct to the Foundation's bank account.        Please send details. Please send me more information on helping the Foundation through my will. My donation cheque is enclosed Please charge a donation of $ _______ to my credit card I would like to become a member:- Please charge my credit card with the annual membership of $5.00 and a donation of $ ________ Please find enclosed a cheque for the annual membership of $5.00 and a donation of $ ________ Please enter your details below: Name (Mr, Mrs, Ms, Miss) ___________________________________________ Address ________________________________________________________ ____________________________________Tel: ________________________ Credit card details  Bankcard  MasterCard  Visa Card Number Expiry date __________________   Name on Card __________________ Cardholder's Signature ________________________________________ Amount to credit     Amounts of $5 and above qualify for a tax rebate within allowable limits. Attach this receipted form to your tax return.