First Floor, 13 South Terrace
Fremantle Western Australia
PO Box 1555
Fremantle Western Australia 6959
p +618 9336 4544
f +618 9336 4463 admin@kulcha.com.auwww.kulcha.com.au
Office Hours: 9am-5pm
Multicultural Arts
of Western Australia
Multicultural Arts of WA
holds the following Liquor Licence
Licence #: 6230043885
Special Facility Licence
Kulcha Sponsors
Yes! I would like to support KULCHA
and make a tax deductible donation!
Amount:
$200
$2,000
other amount
OR
an annual gift
$5,000
$10,000
$
$
Payment Method:
Electronic Funds Transfer
Please complete the form
and make the funds transfer in the usual way to the account below.
Please use your Family Name as a reference
BSB: 306 048
Account: 5617004
Credit Card
You can give us your credit card details on a secure link on the next page.
Contact Details:
Title
Family Name
Given Names
Organisation
Address
Town/
Suburb
State postcode
Email
Phone (H)
Phone (W)
FAX
Acknowledgement:
I would like my gift to be anonymous.
I would like to be acknowledged in the KULCHA annual report
and on the KULCHA website.
Background: (optional)
Date of Birth (DD/MM/YYYY)
Cultural Background
Languages Spoken
Occupation
Interests
Music
Theatre
Dance
Visual Arts
Film
Other
Verification:
Please enter the five digit verification code above
(five strong digits only)
Thank you for your support of KULCHA Multicultural Arts of Western Australia!
