7/28/2019 MARS Donation Form

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Donation Form

Mountainaire Avian Rescue Society

6817 Headquarters Road

Courtenay BC V9J 1N2 Date of Donation: _______________

Please accept my one time donation of$ __________

Please indicate whether the donation is in memory of, or a gift to, someone else. A card will be

sent to the recipient, acknowledging your gift; if indicated, a Charitable Tax Receipt will be sent

to your mailing address.

In memory of OR gift to (circle one) ________________________________________________

Address for card________________________________________________________________

If you wish to help wildlife for the long term, on a monthly basis, please set up a regular

payment through Canada Helps (follow the links on our website www.wingtips.org)

Tax Receipt Requested? Yes ___ No ___

Visa or Mastercard number

Expiry Date: ____/____ (month/year)

Name on card: _____________________________________ Total Amount: ___________

Signature: ____________________________________________________

Your Name:

Street Address

City, Prov/State

Postal/Zip Code

Phone Number:

E-mail Address:

All personal information will be kept confidential.

Registered Charitable Tax number: #89207 7991 RR0001