WPSHC Donations
 
If you would like to make a donation or request more information, please print this form and fax or mail to the address shown below.
 
I / we would like to donate the amount of: 

$25______    $50______    $100______    $250______    $500______     Other______________

Cheque Enclosed______       Please charge my: ______ VISA card         ______ MasterCard    

Acc # __________________________________ Exp. Date: _____________________________

 
Signature______________________________________________________________________

Mr.____   Mrs.____   Miss____    Ms____

Name/s ______________________________________________________________________

 
Address ______________________________________________________________________

 
Province/State ____________________ Postal Code/Zip _______________________________

 
Country ______________________________________________________________________

 
Telephone (______) ____________________________________________________________

 
_____ I / we have made a provision for a bequest in our will.

_____ Please send me information on making a gift in my will.

Please send me information about _________________________________________________


Please make cheque payable to:
 West Parry Sound Health Centre Foundation
16 James Street, Parry Sound, ON, P2A 1T2
(705) 746-4540 extension 317 ~ Fax (705) 746-9812
email jmilne@in-a-heartbeat.org

   ...making the move of a lifetime...