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In Memory/In Honour Donation Form

I would like to:

donate $ to the Capital Campaign Building Fund
donate $ to the Annual Campaign Equipment and Programs
donate $ as a memoriam gift
donate $ as a restricted donation i.e. Palliative Care
Please specify restricted donation:

I will be making my donation by:

Cheque, payable to "Fairhaven Foundation"
Credit Card (we accept VISA or MasterCard)*

*A Foundation representative will contact you to receive your credit card information.

I would like to make my donation:

In memory of:
In honour of:

Donor Information:

Name:
Mailing Address:
 
Email:
Telephone:

Fairhaven Foundation is a registered charity, Revenue Canada Charitable
Business Number: 86880 1945 RR001. All donations over $10.00 receive a tax receipt.

      

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