Mail in Donation Form

The Canadian Association of Professionals with Disabilities respects your privacy. This form is for our use only. We do not lend or sell any of your personal information.

Please print this form, complete and return it to us.

Your Name:________________________________________

Address:__________________________________________

City: _________________________Province: ___________________ Postal Code: _______________

Phone (including area code): ___________________ Fax (including area code): _______________

E-mail: __________________________________________

May we correspond with you via e-mail? ____ yes ____no

Amount of Gift: $__________

If you would like to make this donation in tribute to the memory or in the honour of someone or a special occasion, please complete the following section.

I would like to make my gift in ____ memory or in _____ honour of: _________________________

Please send a card notifying the person, family, or occasion of my tribute gift? ____ yes ____no (Amount of gift will not be disclosed unless requested)

If yes, please send card to:

Name:_________________________________________

Address:__________________________________________

City: _________________________Province: ___________________Postal Code: _______________

Relationship to the person/occasion in memory or honour of:___________________________

Please add my mailing address to the tribute card to identify me as the sender? ____ yes ____no

What personal note do you want us to include in this card - if any?_____________________________

_________________________________________________________________________________

Please make cheque payable to the Canadian Association of Professionals with Disabilities. Send the completed form with your cheque to:

Canadian Association of Professionals with Disabilities
714 Warder Place
Victoria, British Columbia V9A 7H6

Thank you for your contribution.

**Please note that the Canadian Association of Professionals with Disabilities is a federally incorporated non-profit and not a registered charity. Donations are not tax deductible.

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