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Donation Form
Donor Information (please print)
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Name |
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Address |
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City |
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Province |
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Postal Code |
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Telephone (home) |
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Telephone (business) |
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E-mail |
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I (we) would like to make a donation of:{ $35{ $50{ $100{ other$____________
Donation made on behalf of or in memory of ______________________________________________
I (we) plan to make this contribution in the form of: cash cheque credit card other
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Credit card type |
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Credit card number |
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Expiration date |
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Authorized signature |
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Please note: This is not a tax receipt. Donations of $20 or more will receive a charitable receipt by mail.