Global Volunteer Network

Name:	_______________________________

Country you are volunteering in:	_______________________________

Mailing Address:	_______________________________ _______________________________ _______________________________ _______________________________

	Please find a check (cheque)/bank draft inclosed for US$275.00

	I authorize the Global Volunteer Network to charge the (US$275.00) application fee to my credit card in the below currency: United States Dollars ($275.00)

	Please select credit card type: Visa Mastercard American Express

Name (as it appears on card):	_______________________________

Card Number:	_______________________________

Expiration Date:	_______________________________

Print this form and fax/post it to us at: Global Volunteer Network Ltd, P O Box 2231, Wellington, New Zealand. Fax (within NZ) 04 569 9081 Fax (from US) 01164 4 569 9081 Fax (from CA) 01164 4 569 9081 Fax (from UK) 0064 4 569 9081 Fax (elsewhere) +++64 4 569 9081 Please note: After you have posted or faxed the form. Can you please notify us at the following email address: payment@volunteer.org.nz - Thank you!

Is there any thing further you would like to know at this stage?
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