Donor Commitment Form

"*" indicates required fields

Name:*

Organization Name:*

Phone:*

Email:*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Gift Amount:*

Payment Timing*

One-Time Payment

Multi-Year Pledge

My Pledge will start on:*

My multi-year pledge to be paid out over*

My pledge will be paid:*

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Your Signature*

Today's Date:*

Please contact us at [email protected] or (778) 956-9663 for the next steps
on making your contribution, or if you have any questions.

185-911 Yates St. Victoria, BC V8V 4Y9

Phone: (778) 956-9663
E-mail: [email protected]

Charity Number 827676867 RR0001