Menkes Disease

The Kaishi Akizuki Memorial Fund

Donation Form

If you would like to make a donation to support research into Menkes Disease in memory of Kaishi Akizuki, please print and complete this page. or : Donation form pdf (this will open in a separate window)

Please find enclosed/delivered to the nominated bank account (*) my donation to Deakin University in the amount of $___________. I am making this donation for the express purpose of supporting the research of the University into Menkes Disease in memory of Kaishi Akizuki. If at any time a separate trust is established for the benefit of Menkes Disease research at Deakin University, it is my wish that my donation, or so much of my donation as then remains, should be added to such trust if permitted by the deed by which the trust is established. If funds are not fully expended at the end of the research program, I understand that the unused funds will be returned to the donors in proportion to the size of the donation.

Name of donor: ______________________________________________________
Address of donor (to enable delivery of receipt):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

(*) Account details for donation by means of Electronic Funds Transfer:
Name of Bank: ANZ Banking Group
Branch Address: Deakin University, Geelong Victoria 3217, Australia
Account name: Deakin University Council Account
BSB: 013644
Account Number: 314103416
SWIFT/BIC Code: ANZBAU3M

Please mail the completed form if you are making donations by Electronic Funds Transfer or alternatively mail the form and cheque if this is your preferred method of donation.

Forms should be forwarded to:

Mr Michael Holmes
Technical Manager
School of Life and Environmental Sciences
Deakin University
221 Burwood Highway
Burwood Victoria 3125
Australia

Menkes Disease Research is carried out in the Centre for Cellular and Molecular Biology, School of Life and Environmental Sciences, Deakin University, Victoria, Australia, by Professor Julian F.B. Mercer and his team.