TEAM IN TRAINING
DONATION FORM (FALL FY14)
YES! I would like to make a donation to The Leukemia & Lymphoma Society of Canada to
support Team In Training and the efforts of the following participant:
PARTICIPANT’S NAME:
PARTICIPANT’S EVENT:
DONATION INFORMATION
AMOUNT:
$500
$400
$300
$200
$100
$50
$25
Other (please specify):
DATE OF DONATION:
TYPE OF DONATION:
Personal Donation
Corporate Donation
MY EMPLOYER WILL MATCH THIS DONATION:
Yes (completed company form attached)
No
DONOR INFORMATION (Please type or print clearly to ensure your receipt information will be accurate)
NAME:
EMPLOYER:
MAILING ADDRESS:
CITY:
PROVINCE:
POSTAL CODE:
HM PHONE:
WK PHONE:
CL PHONE:
EMAIL ADDRESS:
WOULD YOU LIKE A TAX RECEIPT (An official Canadian income tax receipt will be issued for donations of $25 or more
where the donor’s complete mailing address has been provided. For donations of less than $25, a receipt will be issued
upon request)?
Yes
No
FOR CORPORATE OR US RESIDENT DONATIONS, A LETTER ACKNOWLEDGING DONATION IS SUFFICIENT?
Yes
No
PAYMENT INFORMATION
I HAVE ENCLOSED A CHEQUE (please make payable to “The Leukemia & Lymphoma Society of Canada” and write the
name of the walker/runner in the memo field)
PLEASE CHARGE MY CREDIT CARD
Type of Card:
MC
VISA
Card Number:
Name As It Appears On Card:
AMEX
Expiry Date:
Security Code:
Signature:
THANK YOU FOR YOUR KIND & GENEROUS SUPPORT!
Please mail or fax this form and cheques to the following address:
The Leukemia & Lymphoma Society of Canada
Team In Training
1255 University, Suite 705
Montreal, QC H3B 3W1
Tel. 514-875-1000 Fax. 514-875-2657
FOR OFFICE USE ONLY
HALIFAX BRANCH: 1435 BUSINESS UNIT: 1 FALL FY14 (56797)
MARITIME RACE WEEKEND (394934) – BERLIN (391562) – Nike (104021)
RUN (4355) – WALK (4360)
UNR – REC
The Leukemia & Lymphoma Society of Canada (www.llscanada.org)
Charitable Business No. 10762 3654 RR0001
TEAM IN TRAINING DONATION FORM
FALL FY14
PARTICIPANT INFORMATION
PARTICIPANT’S NAME:
PARTICIPANT’S EVENT:
DONATION INFORMATION (Please type or print clearly. Tax receipts will only be issued if ALL information is complete and legible)
POSTAL
RECEIPT
DONOR NAME OR EVENT
MAILING ADDRESS (street #, city, province)
CODE
REQUIRED?
(required)
($25 min)
Y
N
DONATION
AMOUNT
$
Y
N
$
Y
N
$
Y
N
$
Y
N
$
Y
N
$
Y
N
$
Y
N
$
TOTAL DONATIONS
$
Please do not mail cash. Instead, kindly write a cheque or provide your credit card number to cover the cash donation amount. Please make cheques payable to “The Leukemia
& Lymphoma Society of Canada” and write your name in the memo field. An official Canadian income tax receipt will be issued for donations of $25 or more where the donor’s
complete mailing address is provided. For donations of less than $25, a receipt will be issued upon request.
Please mail this form and cheques to the following address:
The Leukemia & Lymphoma Society of Canada
Team In Training
1255 University, Suite 705
Montreal, QC H3B 3W1
Tel. 514-875-1000 Fax. 514-875-2657
FOR OFFICE USE ONLY
The Leukemia & Lymphoma Society of Canada (www.llscanada.org)
HALIFAX BRANCH: 1435 BUSINESS UNIT: 1 FALL FY14 (56797)
MARITIME RACE WEEKEND (394934) – BERLIN (391562) – Nike (104021)
RUN (4355) – WALK (4360)
UNR – REC
Charitable Business No. 10762 3654 RR0001