Bedpan Run Pledge Forms

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Event Name: ____2nd Annual QEH/PCH Bedpan Trophy Relay – June 18, 2016___
Participant’s Name: _____________________________________________
TEAM NAME: __________________________________________________
Minimum pledge total
of $25.00 to be enter.
Pledges $10 and higher are eligible for a tax receipt. All fields below must be filled out to receive a charitable tax receipt.
Runners/participants are not eligible for a charitable receipt due to value received.
Donation
Method of
Donor First and Last Name
Street/Mailing Address
City
Prov.
Postal Code
Amount
Payment
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
TOTAL
Note:
Donations by Credit Card can be made by donating online at , or , or over the phone by calling the QEH
Foundation at 902-894-2425, or the PCH Foundation at 902-432-2547.

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