Yes!
I would like to contribute to the Canadian Helen Keller Centre
Yes!
I would like to receive more information
Questions:
Name:
Address:
City:
Province:
Postal
Code:
Phone:
Fax:
E-mail:
I am making my donation by:
Cheque
Money
order
Would you like a charitable receipt?
Yes
No
Name on receipt:
An acknowledgment of your gift will be sent to the address above.
If you have made this donation in memory of an individual please
list the name and address where you would like the acknowledgment
sent.
Thank
you for supporting the Canadian Heller Keller Centre!
Please mail or fax this form back to the address at the top of the
page
