Donation Amount:
Your Name:
Company: (only if this donation is on behalf of a company, reciept will be issued to the name of the company)
Mailing Address:
Mailing Address 2: (optional line)
City:
Province:
Postal Code:
Phone Number:
Email Address:
Would you like to dedicate this donation? No Yes, in memory of Yes, in honour of Yes, for the birthday of Yes, for the retirement of Yes, in recognition of Yes, for the anniversary of Yes, for the wedding of Yes, for the gift for
I will notify this person on my own Please email this person a thank you message to: Please mail this person a thank you card to this address: (we only mail out cards for amounts $100+)
Is this donation anonymous? No Yes
Do you wish to receive a tax deductible donation receipt? No Yes
Do you give us permission to recognize your donation on our website? Yes No Just my name (no amount) We will list your name, amount, and if applicable in memory/behalf of/honour of details
Additional Information: If desired, you may leave us other commentsany other optional information:
You will be given ways to process or send your donation after you submit your pledge.
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