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Annual Report 2016/2017 Working in partnership with the community to enhance health care.

Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

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Page 1: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

Annual Report 2016/2017

Working in partnership with the community to enhance health care.

Page 2: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

Thanks to you, our donorsThe transformation of health care is, of course, not an easy task. It takes people with a shared vision and passion to build the best health care system in the world – and that is what is taking place at right here in the Fraser Valley, because of partners like you.

Our hospitals and health care teams provide some of the best care – partly because of the generosity of our donors. We will continue to work hard to ensure the best care is here when you, or your loved ones need it.

Your donations – regardless of size – make a tremendous impact for patients and their families. Fraser Valley Health Care Foundation invests donated funds to help provide the people, places, programs and tools our health care teams need to best serve the people of the Fraser Valley.

MESSAGE FROM THE CHAIRWe never take for granted the connection we have to the hospital and its patients.

We have patients come by and share stories of the great care they received. Physicians and nurses drop in to let us know that, thanks to a new piece of equipment provided by donors, they’ve shortened wait times or improved the standard of care they can offer. We have loved ones sending notes of gratitude for small comfort items that made their stay a little easier.

We work in a unique environment, where the goal is always to improve the health and vitality of patients. Every day we learn something new about the services provided, the medical teams we have on site, and the challenges in providing great care.

It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay Lions Clubs completed there Centennial Legacy Project by raising $600,000 to purchase 6 pieces of equipment for the Eye Centre at Chilliwack General Hospital. The Chilliwack hospital also received a new echocardiogram machine. An Ultrasound machine and ventilator were purchased for Abbotsford Regional Hospital; Mission Memorial Hospital received a Gastrascope, Colonoscope and Beamer Mate Electrosurgical Generator. Hope received a new bus for the residents to use who live in the community and at the Fraser Canyon Lodge.

Your support of healthcare in our community has made a tremendous difference. Thank you for your contribution to improve the health care available to our families and our neighbours.

It’s truer than ever before – together we change lives.

Carron Gerry

ChairFraser Valley Health Care Foundation

Page 3: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

AuxiliariesAuxiliary to Fraser Canyon HospitalAuxiliary to the Abbotsford Regional HospitalChilliwack Hospital AuxiliaryChilliwack Hospital Service LeagueMission Health Care Auxiliary Society

FoundationsAbbotsford Community FoundationAbundance CanadaCanada Helps. orgChilliwack FoundationChimp FoundationCN - Volunteer GrantLink Charity Canada Inc.RBC FoundationRotary Club of AbbotsfordShoppers Drug Mart - Life FoundationSoroptimist International of ChilliwackTeam Telus CaresTD Bank - Caring Together Volunteer GrantThe Tong and Geraldine Louie Family FoundationVancouver FoundationUnited Way of the Fraser ValleyVariety - The Children’s Charity

Service Clubs and AssociationsAbbotsford Tulip Festival VolunteersChilliwack Symphony Orchestra & ChorusFort Langley LionsFraser Valley Indo-Canadian Business AssociationGrand Chapter of BC & Yukon Order of The Eastern StarHope United Church WomenKiwanis Club of SardisKnight Road Legacy AssociationKnights of Columbus Chilliwack Council # 3478MSA Soccer ClubNarcotics AnonymousRotary Club of Chilliwack-FraserRotary Club of HopeRoyal Canadian Legion # 15 - Ladies AuxiliaryRoyal Canadian Legion Branch

# 265 - Poppy FundRoyal Canadian Legion

Branch # 57The Hospital Group

The Mount Cheam LionsWellness Committee - ARH

Corporations0893891 BC LTD

556383 BC LTDAlpine Valley Disposal

BC Lions Football Club Inc.

CarStarCalm & Cents BookkeepingCedar Tree Investment CanadaChilliwack Division of Family PracticeChilliwack Sports Entertainment Limited PartnershipCity of ChilliwackDancing In Time ProductionsDr. C.J. Van Der Merwe Inc.Dr. David a. Heinrichs IncDr. Jody Ching Inc.Dr. W DebruinDyal Farms LtdESLI Study Tour GroupFraser HealthG & A FarmingGardner Chevrolet Buick GMC Ltd.Grand Pappy’s Home FurnitureHailey Dean Films IncK-Bro Linen Systems IncKhalsa Credit UnionLordco Auto PartsMario’s Towing - Hope DivisionMedtronic of Canada Ltd.Michael Yatscoff Professional CorpMill Creek Coffee CompanyOgilvie Mtn Holdings LtdPrecious Productions IncPharmasave Health Centre #056Quorum Construction LtdRoyal LePage - Little Oak Realty Royal LePage Wheeler Cheam RealtySafeway ChilliwackSB Productions IncSchool District #33 (Chilliwack)School District #75 (Mission)School District #78 (Hope)Spectra EnergyTim HortonsTicknor Restaurants LtdVan-West Consultants Ltd.Vision International Resources Inc.

Estate GiftsEstate of Ellen MargaretDoughtyEstate of Anna FredricksonEstate of George McElroyEstate of Vernon RoachEstate of George Frank Nelson

In Honour OfAmar S. SandhuSurjit SandhuVill Manuke

In Memory OfAlan CummingsAmari MankatalaArchie I. McLeodAudrey ClaytonBetty GastBlanche PorterBonnie MaksymetzBrent WilsonBrandon MillionCarol BoyesCarol HarackCindy ThomsenClaudette FowleCleon SawyerCorrine KetelaarDanny NgDieter H. RoellEllen N. SpenceEmily I. DrewErnie TempleErv HeierHarold SloanJack DouglasJohn H. SteenbergenJohn WiensLarry AlexanderLayla LockeLorne CopemanLydia DargatzMarilyn MunnMarguerite RitchieMurray HarrisPatrick MaguireRalph RosenthalRobert BridgerRobert RobertsonRobert StoneRod BlatnyRoy A. NorthropSandra DavidsonStella SimpsonStella KirkTimmy MuxlowVelma E. SzmutkoVernon QuadlingW. Margaret BukerWilliam C. MacDonaldWilliam Mead

Indivudal DonorsMichael AdkinsTed AelbersCornelius and Anne AkkermanElizabeth AllenGisele AllenSeyed AmirkhaliliArthur and Margaret AndersonGrace M. AndersonJim and Julia AndersonPaul and Rose AndersonYolande AndersonNorris and Barbara AndreasenRonald and Deborah AngellPatricia ApplebyMitsuo ArakiAgnes ArchibaldHorace ArmoogumAllan AsapidHerb AssmanBashiran and Abdul AzizDarrell and Jorina Balbar

Cliff and Valerie BaragerM. Alice BassoW. Richard and Barbara BateAman BathRajinder and Jaswinder BatheValerie BaxterLaureen BeatonKyle BeauregardErwin and Martha BecherRaymond BeckCharles and Dagmar Belli-BivakMichael and Jane BentleyDonald and Anne-Lise BergArnold and Hazel BergenDolores BergermannKate BerkiwKevin BerrymanJohn BethelTom BiggJoan BirdCindy BishKarl-Heinz and Susan BlankMr. Ernie Doerksen and Ms. Janet E. BoldtJoyce BookerLen and Jessie BorleyApril BourkeAnson and Eileen BoyleAndrew BracewellChristopher BradenNavdeep BrarCarol BridgerEdward and Loretta BrienJoanne BrownJohn and Dianne BruinsmaKerrison BurleighArlene BurtniakFred ButlerGarfield and Linda ButlerEvelyn CallahanLinda CalwillBeulah CampbellCameron and Janet CampbellHarry and Joyce CarlsonBonnie CarmichaelRodney and Mary CarmichaelDonna CarsonAl and Jacquelyn CarsonBobahavneet ChahalLaura ChildDoris ChorneyDr. Holden Chow and Ms. Jasmine CohenDawn ChubaiJoyce CloughAaron CoakwellDaryl and Carla CollinsEleanor CollopyPatricia ConneelyIrma CooperDavid CoppinMaxwell CornwellJohn CorrieJules and Renee CossetteSolms CoutinhoWilliam and Darlene CoxIan and Karen CraigTerry CroteauMark CummingWilliam and Karen CunninghamWilliam CurnewWinnifred CurryEta CzeneZoltan and Dagmar DanoChristine Darrah

Doug and Hannah DavieAnn de JongCorrie DekkerDorothy DelongMarkus DelvesManny DeolLarry and Lorraine DepowCurt DerksenDenise DesorcyJohn and Lorraine DesrochesSadru DhallaHarpreet DhillonCheryl DickieLoraine DinnWerner and Gertraud DirksGary DirksenNancy DobsonKatherine DoerksenC. DollingTed and Marguerite DomanSandra DoullFrances DoyscherChristine DriscollLou DumesnilTricia DumouchelCora DunlopGladys DyckIrvin and Tangy DyckMr. Phil Dyer and Ms. Renee RacineGeorge and Jenny DykemaFred and June EckertBob EdwardsViolet EdwardsSusana EgolfJonas ElanderSeverino EmnacenClarence and Gerda EngelkingGerry EnnisSandy EnnisGeorge and Adelaide EppJason and Melanie EppBrenda EvansGeorge and Barbara EvertonAttilio and Helen FabbroMildred FarrellFrieda FastHarriet FaulknerJacob and Barbara FauthPieter and Lolkje FeddemaFred and Cheryl FeistmannRalph and Sina FennemaGary and Donna FergusonJennifer FieldUwe and Edith FischerChristel FisherLorne and Mary FisherWilliam and Arlene and Arlene FitzgeraldAird and Sheila FlavelleMr. & Mrs. FlierWendy ForcierLewis FosterPatricia FowlesWilliam and Benita FrancisErnestine FransonVerne and Maria FrantzBob and Doris FraserWolf FriedrichLinda FrimerDavid FroesePeter FryKathy FunkDarilyn GabrysJim GaetzMayor Sharon Gaetz and Mr. Jim Gaetz

Thank You to Our Donors!

Page 4: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

Harald GehnAlbert GibsonJanet GibsonDavid GiesbrechtJim GiesbrechtDennis GieslerHardip GillBeth GillespieKen GillisStuart and Sherrie GillisLinda GilzeanDorene GingerichDenis and Helen GirouxArthur and Lois GoertzDon GoertzJohn and Louise GoertzenWilliam GoerzenMichael and Donna GoodeyShelley GossettEldon and Nelly GoudzwaardDavid GouldCatharina GrannemanMarc GreidanusUdham GrewalJohn and Audrey GrisnichRoy and Cheryl GroothofGerry and Jane GrunauAngus and Sandra HaggartyGeorge HamanishiIva HancockPatricia HannaAugust and Heather HanssonBen HarderJacques HardyCharles and June HarleyPhyllis HarmsBeverly HarrisSean and Elizabeth HarrisGregory HarrisJohn HartwickJames HaskayneE. Mary HaynesFrank and Eva HeckertRobert and Vella HendersonTodd HendricksonGlenn and Barbara HenryAgnes HeskethMr. Seyed HeydariLois HildebrandtPatricia HillScott and Tina HindsChein HoCharles and Monica HofsColetta HolmesArthur and Victoria HoockMarie-Aline HoodHardy and Ethel HoogeJohn and Jean HoogendoornWilliam and Susan HooperEdward and Judith HopkoJudith HornerCatherine HoughNorman and Florence HowellDavid and Lorraine HughesRavleen HundalDavid and Margaret HunterShirley HylkemaTricia IbergNorman and Nicole IrelandPat IrvingKim IsaacHenry and Stella IzattEric JackmanLloyd and Agnes JacksonMurray and Denise JacksonMarlene JankovitsAnita JansenDaphne Jennings

Jas JohalTarsem Singh JohalTerry and Anita JohnstoneMelinda JonesErnst and Hildegard KahlerSohan and Gurnam KahlonRichard KalynTony and Catharina KarduxShirley KavanaghLinda KawaguchiDan KeeleyDavid and Colleen KeilTheresia KellerElfi KendallLenore KennedySpencer KentDoreene KerrEsther KerrStewart and Doreen KeyDennis KiffiakTom KimBeverly KlassenDale KlerKen and Joan KnightDoris and Robert KnoxMary KoenigMarilyn KoppIsabelle KovacsPeter and Christine KowalskiMargaret KristjansonGennady KrivoyFrederick and Arlene KroppAlex and Olga KunzSubramaniam and Jacoba KuppusamyDan LahamMargaret LaHayJonathan LambertDonald LanovilleAlma LantingFrances LarushGordon LaurentFrederick and Mary LawrenceGerald and Sharon LawrenceLouise LeBlancHenry and Lilly LegaultKarenjit LehalWendy LeighEileen LemnaRoy LemonJodi LenzDavid and Nedra LightfootManfred LinauIris LiuShirley LivingstoneHenry and Mary LloyndEwart and Eva LockLawrence and Adele LofgrenLloyd and Donna LofgrenDonna LoganLorenz and Hannelore LohningerThomas LordHannelore LubbenMary LucasJohn and Carla LuijkxJames and Lauretta LumsdenEdith MacDonaldReta MackayDenise MacleanJeff MacLeanNeil and Roberta MacLeanKenneth MacPhersonJorda MaiseyRonald and Gail ManningArlene MariniHelen MarshallDwayne and Catherine MartinWendy Matus

Edward and Nancy MawsonBonnie McEwanRobert McFaddenPatricia McGiffinDebbie McGimpseyWilliam and Doreen McGonigalEdward McGrathAndrew and Lorraine McInroyKenneth and Joan McIntoshPatricia McKinleyColin McLarenHarold McLellandRoss McLeodKerrin McMahenBetty McMahonYvonne McPhedranRobert McPhersonKelly and Solfrid MeadeGisela MegrathMary-Lee MerzDiane MeyerinkMichael MiddletonSteve MiddletonDan MikiKristi MintzDonald and Frances MitchellJean MitchellPhyllis MitchellGrace MoorePaul MorganGysbertje MorrenJennifer MorrisonWalter and Sherry MudeRobert MuirStanley and Phyllis MunroEd and Kelly MusselmanMike MutterOwen and Jacquelyn NelmesAudrey NeufeldAlbert and Pearl NewmanCecil and Meta NicolsonErnie and Fatima NovixMartin and Evelyn NowoselskiLouis and Mary NyulMichael and Judith O’CainGary and Gary & Debbie OhlhausenBrad and Diane OlafsonWilly and Verlene OlsenJerry and Sasha OlynykKayo and Kunio OtsukaTrudy ParkeBakhtawar and Kanta ParmarKerry PashakBetty-Lou PatienceBarbara PatrickJesusa PearceSusan PelzerLeedia PenneyF.L. PhillipsKaren PickfordDennis and Patti PillingBrian and Jane PinkertonMr. Gilles Plouffe and Ms. Diane A. BradleyRobert and Rosalind PlumtreeTom PotterPeter and Margaret ProbyJose QuezadaLorena, Vicki & Albert QuiriconiBarinder RagodeDean RampageRobert and Ann RamsbottomL. Beryl ReidJim ReimerDonald and Margaret ReimerSherry Reimer

Jon and Karen RevaneArthur and Eunice RidgwayChristopher and Brenda RobertsDebbie RobertsShirley RollheiserDennis and Linda RookJean RotheryGerry and Grace RustulkaChris RyanJackie SandveGurmit Singh SanghaSherry SaranGrace SarisHeinz SchillerEric SchmidtBrian and Joan SchmidtRainer and Christine SchoeffelCarol SchofieldMartha SchroederFabian SchwarzDonald and Louine SciottiElisabeth ScotsonJagroop SekhonBillie SemakAnn SenaeJames and Jean ServiziHugh and Dalyn SexsmithMr. B. White and Mrs. Blanche SherwoodJohn and Audrey ShortRandy SiekhamGail SimpsonNeil SimpsonRasmus and Joan SjovoldPeter-William SladeAnn SlaterC. Delmarque SmithFrank SmithMargaret SmithWesley SmithHildegard SolbergNeeraj SoodDiane SowunmiVirginia SpetchHeather StearnCornell StefaniukTheo and Maria SterkenburgAndrea StillerHarvey and Claire StinsonMatthew and Beverly StirratWilliam and Jean StoneIsabella StraughanEric and Annette StromLee StruthersJim & Margaret Sturt-SmithNaveen and Yolande SuriWalter and Beryl SusselLynne SweetingSteve and Helen SzaboKris SzigetiNahed TadrousDeanna TallDoreen TapeFrank TaylorNicholas TaylorPaula TaylorR. Glenn and Frances TaylorSusan TegtmeierWilly TerpstraSucha ThandiRosemary TheedomMadeleine ThiessenManjit ThindAnita ThompsonRobert and Sandra ThompsonChristine ThomsonMatt TinsleyEdward and Irene Tisdale

Ann ToddM. ToewsJagdish ToorOskar TronstadRobin TsengKatie TuchakWilliam and Valerie TunbridgeVenette TurekPeter and Nicole TuytelPieter and Elizabeth TuytelJohn and Jo TymoschukMaarten Van BlijenburghDianne van den BrinkValerie Van Den RaadtHillie Van EllenbergElizabeth Van GamerenGerry Van HierdenMelanie and Roy VanceGerry and Carol VandenbrinkWilliam and Elaine VanderspekEngel and Jane VanderveenMike VanderveenTony and Nicky VanderwalAlexander VanhaasterPeter and Christine VantilPieter and Mary VanwoudenbergCathy VerkerkAlbert and Joanne VerschuurDavid VerwoerdJohanna VerwoertJane ViganoLeonard and Susan VisscherGerald VrieselaarLorne and Norma WalbergMr. Jim Dewes and Mrs. Colleen WalkerRandy WalkerDon WardCornelius WarmerdamSandra WatsonFrank WawrychukJean WeaverNora WebbAnn WebsterShawn WebsterCurtis and Elaine WeeksRussell and Fern WellsCharles and B. Joan WhieldonJoan WhiteArley WhitewayGarry and Mary Jo WhitneyErika WhittakerIan and Diane WickerMartha WiebePaul WiebeStan WiebeLewis and Joan WilcoxFred and Eva WilgenofNorman and Alice WilliamsErnest WillmsGordon and Johanne WilsonRonald and Bernice WilsonCarol WinsorMarissa WoodTerri - Lou WoodsJames WoolfordKenneth and Shirley WotherspoonWally WozneySusan WraytonMichael and Joan WrightKurt and Susan WylerNicole YardleyRandall YatscoffMatthew and Marie YelichRay YenkanaDebra Yeoman

Page 5: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

Telemetry Packs

Page 6: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

DEPARTMENT EQUIPMENT QUANTITY AMOUNT

Medical Imaging Vascular C-Arm 1 $307,500

ICU Ventilator 4 to 6 $325,000

ADTP Transportation $37,500

Cottage Roho Mattress 1 $8,991.25

DEPARTMENT EQUIPMENT QUANTITY AMOUNT

Medicine/PATH Removal of Tubs $12,500

Morgue Renovations $125,000

TRIM PARO Social Pet Robot 1 $12,500

DEPARTMENT EQUIPMENT QUANTITY AMOUNT

Whatever It Takes – helps get patients home sooner $6,250

Emergency Stretcher, Trauma, Bariatric 2 $27,500

Surg Day Care Stretcher, Bariatric 1 $13,750

Surgery NU4 Bed, Bariatric 1 $30,000

Bradley Centre Beds 10 $56,250

Heritage Village Blanket Warmer 1 $9,375

DEPARTMENT EQUIPMENT QUANTITY AMOUNT

Emergency Defibrillator/Monitor LP 15x2 2 $75,000

Residential Bariatric Bed 1 $30,000

Medicine Isogel Mattress 10 $47,500

DEPARTMENT EQUIPMENT QUANTITY AMOUNT

Emergency Simulation Lab $100,000

Primary Care Stretcher Bed 10 $10,000

Laboratory Instrument, Licence, Service & Software $637,500

OR - Gyne/obs Myosure Scopes 4 $6,250 each

Laboratory Instrument, Licence, & Service $196,250

Maternity Baby Weighing Scale 1 $419.94

Maternity Mattress 6 $652.50 Each

Mental Health Whatever It Takes Funds On going

Entire Hospital Stretcher Beds 8 $12,675 Each

Laboratory Instrument, Licence, & Service $78,750

Medicine Ceiling Lifts 12 $12,000

CMH Mechanical Lifts 2 $7,608.75

Laboratory Instrument, Licence, & Service $98,375

5-2-1-0 Program Activity Box 1 $5,000

Thank you for your generosity.

We partner with donors to provide essential funds to ensure Fraser Health’s highest priorities are met so that our health care teams can deliver care for children, adults and seniors.

The BC Government funds day-to-day operations and administrative costs, but donors fund the extra equipment, innovative technology, education, and enhanced patient care and programs we need to save lives.

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2017/2018 PRIORITY NEEDS

Page 7: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

ALL AGES

Chapters , Tim Hortons, Starbucks gift cardsPlaying cardsBoard gamesHairbrushesHair elasticsBooksTravel size toothpasteTravel size deodorantHats & mittensSocks & jogging pants

CHILDREN AND YOUTH

Lego Sets (small, individual sized)All plastic baby dolls (no cloth bodies)Fisher Price Little PeopleHot Wheels cars (singles or multi packs)Toy trains – Thomas or other wooden onesSoft rubber balls to play catch assorted sizesBooksModel kitsShopkins / BarbiesBoard gamesToys R Us gift cardsNail art craftsSelf-contained craft kits (beads, mosaics, beads,)Small wooden projects or modelling clayPlay-Doh, modeling clayCrayons, felts, pencil crayons, pastels, paintsBubbles(small individual ones)General craft supplies, ie. pom poms, glue sticks,

scissors, pipe cleaners, stickers, etc.

EVERYDAY NEEDS

Toiletry sets (ex: Body Shop sets, Axe, etc)Gift Cards (ex: Tim Horton’s Starbucks, iTunes,

Chapters, clothing stores)Infant toysPortable DVD player & DVDs

Support children and young adults who are in the hospital this holiday season with a small gift

INFANTS

Infant development toys (e.g. stacking cups, rings, LaMaze brand toys)Rattles, balls (e.g. O-Ball, Sensory)BooksWooden toys (e.g. Hape, HABA, Melissa & Doug, Puzzles)Night-time bedside projectorCrib side music and image players ( e.g. Fisher Price Ocean Wonders Aquarium)Infant electronic learning toys (e.g. V-tech)Musical instruments for babiesToy phones

Hospital Christmas Comforts2017 WISH List

All donations must be new and unwrapped. Due to infection control, we cannot accept used toys of any kind. Please no toys or action figures with weapons or violent themes

Please deliver your items to your local Fraser Valley Health Care Foundation office.

ELECTRONICS

DVD’s – TV series, anything rated G, PG, PG- 13, 14A (NO rated R please)

Movies and TV series for teensiPodsNintendo DSPortable DVD players

Page 8: Working in partnership with the community to enhance ...€¦ · It has been a very busy year in the Fraser Valley. In January of 2017 the Mount Cheam Lions Club and Steller’s Jay

4518934Regional Office32900 Marshall RdAbbotsford, BC V2S 0C2

Fraser Valley Health Care Foundation | Regional Office 32900 Marshall Rd, Abbotsford, BC V2S 0C2

1 877 661 0314 | www.fvhcf.ca | Charitable Business Number: 87115 6725 RR0001

Fraser Valley Health Care Foundation works with the

community to support the local hospital, facilities and

programs run by Fraser Health.

Yes! I would like to donate to Fraser Valley Health Care Foundation.

METHOD OF PAYMENT

DONOR INFORMATION

Mission

To improve the quality of health care for our local

communities.

Vision

Individual Corporate Service Clubs / Associations Other

DONATION AMOUNT $

FULL NAME OF INDIVIDUAL OR LEGAL NAME OF CORPORATION

NAME RELATIONSHIP

ADDRESS CITY PROVINCE POSTAL CODE

CARD NUMBER EXPIRY DATE(MM/YY)

ADDRESS CITY PROVINCE POSTAL CODE

TELEPHONE EMAIL

NAME ON CARD SIGNATURE

PLEASE SEND ACKNOWLEDGEMENT TO:

Donor would like to remain anonymous

Please use my gift towards the greatest need overall

Please use my gift towards the greatest need in: Abbotsford Mission Chilliwack Hope

Please use my gift towards

In Memory of

I HAVE ENCLOSED A CHEQUE PAYABLE TO FRASER VALLEY HEALTH CARE FOUNDATION

VISA MASTERCARD

Sam Sample1234 Any Street16145 FVHCF Annual Newstetter NLAny City Prov V0V 0V0