$35 $50 $100 $250 $500 $1,000

Other (please specify amount in dollars) $

Please charge my Visa Mastercard American Express

Name as it appears on the card:

Card Number:

Expiry Date: 01 02 03 04 05 06 07 08 09 10 11 12 2007 2008 2009 2010 2011 2012 2013

Please send my tax receipt to:

Name:

Street Address:

City:

Province:

Postal Code:

Email Address:

Please direct my donation to the following care facility: select care facility Aberdeen Glengarry Mt. Tolmie Priory Heritage Woods Direct where most needed

If you have any further wishes on the use of your donation, please note them below:

I would like to make a monthly gift of $ through an automatic charge to my bank account or credit card.

Please charge my:

Visa Mastercard American Express Bank Account

Name as it appears on the card:

I will receive a tax receipt at the end of each calendar year for my accumulated donations. I reserve the right to cancel this arrangement at any time. Please send the appropriate paperwork to me at:

Name:

Street Address:

City:

Province:

Postal Code:

Email Address:

Please contact me to discuss how I can give publicly traded shares of stock to the foundation.

Please send me information on how I can leave a legacy of care through a planned gift such as a bequest in my Will.

Memorial and Tribute Gifts Section: MORE INFORMATION

Memorial Gift Tribute Gift

Name of the person who is being honoured by this gift:

Name and address of the person you wish the Foundation to notify that you have made this donation (please note - donation amounts are not revealed unless you request we do so):

Name:

Street Address:

Phone Number (if known):

Relationship to the deceased/person being honoured:

Your donation will be processed on the day your information is received. Your credit card slip and tax receipt will be mailed to you at the address listed on this form.

If you prefer to donate by cheque, please send your donation to:

Greater Victoria Eldercare Foundation
1454 Hillside Avenue
Victoria BC Canada
V8T 2B7