Make A Wish Mail In Gift Form
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1
2M
-A-W
M
-I
G
F
®
AKE
ISH
AIL
N
IFT
ORM
Please make all cheques payable to the
Make-A-Wish chapter that you wish to
donate to or please complete the
payment details below.
Date (mm/dd/yr): ____ /____ / ____
Name: ___________________________________________________________________________________
Address: __________________________________________________________________________________
City: ________________________________ Province: ________________ Postal Code: ________________
Phone: (
) ________________________ Email: ______________________________________________
Enclosed is my gift of: ________________________
□
□
Please add me to the Make-A-Wish:
E-newsletter List
Mailing List
P
(
):
LEASE DESIGNATE MY GIFT AS SELECTED
SELECT ONE
□
Make-A-Wish
Canada. Your generous donation will support wish-granting across the country.
®
□
My local Make-A-Wish chapter. Your generous donation will support wish-granting in the local
region. Please send donation to the appropriate addresses below.
D
A
:
ONATION
MOUNT
Gift Amount: $ __________________
Or I would prefer to donate monthly: $______________ / month
P
I
:
AYMENT
NFO
C
C
C
A
REDIT
ARD
HEQUING
CCOUNT
□
□
Visa
Mastercard
Withdrawal Date: 15
of each month
th
Credit Card #: ___________________________________
Name of bank: ______________________________________
Expiry Date: _____________ / ______________
Account#: _________________________________________
Name on card: __________________________________
Institution #: _________________________________________
______________________________________
Signature:
Branch #: ___________________________________________
I
,
:
F YOU WOULD LIKE TO MAKE A MEMORIAL OR TRIBUTE GIFT
PLEASE COMPLETE THE FOLLOWING SECTION
□
In honour of: _____________________________________________________
□
In memory of: ____________________________________________________
Personal message to be added to the card:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Send gift notification to (name): _____________________________________
Address: ___________________________________________________________________________________________
City: ________________________________ Province: _____________________ Postal Code: __________________
Please mail your completed donation form to the desired Make-A-Wish address listed below.
Please do not mail cash. Thank you for your continued support!
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