Neurological Foundation


Online donations and New Member registration

All online donations and membership sign-ups are processed by DPS (a leading provider of Internet transaction processing in New Zealand and Australia). All payments go through a secure network and you will receive immediate confirmation when the transaction has been processed successfully.

Please take care to enter the correct information below:

Personal Details
 
  Donation Type
  Title
  First Name
  Middle Initial(s)
  Last Name
  Postal Address
  Phone Number
  Alternative Phone Number
  Email Address
 
Details of Donation and Member Registration
 
  Please enter the amount you wish to donate $
     
  Please tick box if you would like to become a member* $5 will be charged to your credit card.
  Renew Subscription $5 will be charged to your credit card.
     
  *Only tick this box if you are not currently a member of the Neurological Foundation. If you tick the box you will be registered as a new member of the Foundation and an additional $5.00 will be charged to your credit card. For more information on what you will receive as a member, click here.
     
  *Please Note: We don't accept American Express