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Donation
& Membership Form
Membership is $20.00 per year (our Society's year runs from August 1st - July 31st) and entitles you to receive our newsletters, and to vote at our annual general meeting.
Please Note:
Membership does not require a volunteer commitment.
| Name |
|
| Address |
|
| City |
|
| Postal
Code |
|
| Phone |
|
| Paid
by |
| Cheque |
 |
VISA |
|
MasterCard |
|
Amex |
|
| Credit
card # |
|
| Expiry
date |
|
| Signature |
|
|
Memorial
Donation |
| The
above donation is in memory of: |
| Name |
|
| Please
send an acknowledgement card to: |
| Name |
|
| Address |
|
|
|
Anonymous
Donation
Please
do not publicly acknowledge my donation. |
|
Thank
you, but I will decline membership at this time. |
| Please
mail completed form to: |
White
Rock Hospice Society
15510 Russell Ave.,
White Rock, B.C.,
CANADA
V4B 2R3
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