Matched Donor Pledge

Matched Donor Pledge Form

Thank you for your interest in becoming a Matched Donor. Your generosity helps double the impact of every donation made during our campaign and strengthens the services we provide to people living with chronic illness across Aotearoa.

1. Donor Information

Full name *

First name

Middle name

Last name

Organisation name (if applicable)

Email address *

Phone

Postal Address

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

2. Pledge Details

I/We pledge a matched donation of:

$500

$1,000

$2,500

$5,000

$10,000

Other $

Match Type

Dollar for dollar match (1:1)

Double match (2:1) — for every $1 donated, I/we will contribute $2

Other match structure (please specify)

Maximum Match amount (This is the total amount you are willing to match).

3. Recognition Preferences

Public Acknowledgement

Anonymous

In honour or in memory of someone

Name to acknowledge:

4. Payment Timing

I/We will provide the matched donation:

At the end of the campaign (after match total is confirmed)

In advance

In instalments (please specify):

5. Agreement

Please read the full Terms Agreement

Click here for the terms and conditions

I/We confirm that I/we have read, understood, and agree to the Terms Agreement *

I/we confirm our intention to participate as a matched donor for the CCI Support Matched Donor Campaign and agree to fulfil the pledged amount. *

Signature *

For more information, please contact the Team at CCI Support

43 Welcome Bay Rd, Welcome Bay, Tauranga 3112
P: 022 658 0251 or 0800 224 7871
E: info@ccisupport.org.nz
W: www.ccisupport.org.nz
Hours: Tues to Friday 9am - 2.30pm

Please check the highlighted fields

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