Donation Request
Order Form
2015-2016
Please read the instructions and processes on the back before completing this section.
Name of Event: ___________________________________________ Date of Event: ______________
Member Name: ____________________________________ email: ____________________________
Phone #: _______________ Type of donation requested:
Over $1000
Under $1000
Promotional Items
Briefly explain your participation with the event/society and why you think this is a positive opportunity
for your union to become involved in. If you are seeking financial support what will the monies be used
for :
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_____________________________________________________________________________________
_____________________________________________________________________________________
Would you like to see a representative of the organization attend to assist/volunteer? ______________
Financial Support
Amount $ _________ Cheque payable to: __________________________________________________
Promotional Material Support
Please use the space below to give examples of the types of promotional material you have used in the
past or would prefer to receive. This will help us to identify if/how we can help you.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
For Office use only:
Date of event: ____________________________ Member Contact: ______________________________________
Manitoba Association of Health Care Professionals
Authorization: _________________________________________ GL: _______________ Class: _______________
Reference #: donation (date)
Donation Request Order Form