Global Volunteer Network: Printable Form for Application Fee

Name:	_______________________________

Country you are volunteering in:	_______________________________

Mailing Address:	_______________________________ _______________________________ _______________________________ _______________________________

I would like to pay:
	Standard Application Fee: US $97
	Lifetime Application Fee: US $197

	Please find a check (cheque)/bank draft enclosed for my fee.
	I authorize the Global Volunteer Network to charge the below fee to my credit card:
	US $97.00
	US $197.00

	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, PO Box 30-968, Lower Hutt, 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: info@volunteer.org.nz - Thank you!

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