Christmas Hamper Referral

Refer someone to receive a hamper from this years DLC Christmas Hamper Appeal

Your contact details

First Name *

Last Name *

Phone Number *

Email Address *

As much as possible we would like the hampers to be delivered by those who are referring them (like yourself) at a time that suits you between the 17th and 20th of December.

If you are unable to deliver the hamper, please ensure you seek permission from the person you are referring to share their contact and delivery details with us so we can deliver it. Please ask permission BEFORE completing this form.

Can you assist us to deliver the hamper to this person/family at a time that suits you between 17th - 20th of December? *

Yes

As you have selected to deliver the hamper yourself, we will not be asking for further identifying contact details of the those who you are referring.

Information about person to receive hamper

Do you have expressed permission from the individuals you are referring to share their personal details with us? *

Yes

As you have selected that you do not have permission to share personal details of this person with us, please ask for permission before completing the reminder of this form.

Is the person/family you are referring in Alice Springs for Christmas? *

Yes

Last Name *

First Name *

Phone Number *

Deliver address for hamper *

Number of People in Household (include how many kids) *

Tell us a bit about them and why you are referring them *