2014 PO Box 1111, Milnerton, 7435, South Africa Tel: +27 21 430 4718 | Fax: +27 86 210 8760 E-mail: [email protected] Website: www.searescue.org.za NPO Reg. No. 002 – 870 Co. Reg. No. 1967/013618/08 Marketer: Jacqui Jacobs You could help save lives! It’s caring people like you who help us to save lives at sea. Please be part of our renowned and exciting Car Competition that helps raise the funds we desperately need. There are only 28 000 tickets available. Each R595 ticket gives you an entry into the fantastic NSRI DOUBLE MITSUBISHI PRIZE DRAW – yes, you could win 2 Mitsubishi vehicles: • 1st GRAND PRIZE: 2 Mitsubishi vehicles – a Pajero and an ASX – together valued at over R800 000! • 2nd prize: R250 000 in cash! – That’s a quarter of a million rand! • 3rd prize: A trip for two on the Queen Mary 2 including return flights, valued at R80 000! Please complete your details below, choose your preferred payment option, and return this form to us either to the fax number or email address above. We will mail you your Confirmation of Entry as soon as your payment is received. No. of Tickets @ R595 each: Name: Company: Postal Address: Code: Tel. (w): Cell: E-Mail: Date of birth: D D / M M M / Y Y Y Y CREDIT CARD Credit Card Holder’s Name: Total Amount: Card Number: Expiry Date: 3 Digit CVV No: (on back of card) M M Y R Y Signature: Date: DIRECT DEPOSIT / EFT BANKING DETAILS Bank: Standard Bank - Sea Point Account Name: National Sea Rescue Institute Branch Code: 024109 Account No: 071041648 • Please use your name and telephone number as a reference so that we can confirm your entry into the competition. • Deposit slips and EFT’s are to be faxed to 086 210 8760 or emailed to [email protected]. • Cheques made payable to NSRI must be crossed and mailed together with this form to PO Box 1111, Milnerton, 7435. WE VALUE YOUR SUPPORT AND WISH YOU LUCK IN THE DRAW. Cleeve Robertson CEO