Donation Form
Donor Information (please print)
|
Name
|
|
|
Address
|
|
|
City
|
|
|
Province
|
|
|
Postal Code
|
|
|
Telephone (home)
|
|
|
Telephone (business)
|
|
|
E-mail
|
|
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
|
Credit card type
|
|
|
Credit card number
|
|
|
Expiration date
|
|
|
Authorized signature
|
|
Please note: This is not a tax receipt. Donations of $20 or more will receive a charitable receipt by mail upon request.