A donation for helping Optimists help Canadian kids. - ccof

A donation for helping Optimists help Canadian kids.
Please send this form with your donation.
All donations are tax deductible. Only contributions of 20$ or more will receive a tax receipt.
The Canadian Children’s Optimist Foundation is a Canadian charity recognized by the Canada
Revenue Agency. Charitable Number: 874718950RR0001
THANK YOU FOR YOUR DONATION!
DFR’s information
DFR Name : _____________________________________ District Number :______ Date :________________________
1. COMPLETE THE DONOR’S INFORMATION
First Name : _________________________________________________________________________________________
Last Name :_____________ ____________________________________________________________________________
Club/Org/Business name: ______________________________________________________________________________
(FOR CLUB, ORGANIZATION OR BUSINESS DONATIONS)
Address:
__________________________________________________________________________________________
City : ______________________________________________________ Prov.: ______ Postal Code : __________________
Club/Member Number : ________________________________ Telephone: ____________________________________
(MANDATORY IF APPLICABLE)
E-Mail : ____________________________________________________________________________________________
2. CHOOSE A TYPE OF GIFT
UNRESTRICTED GIFT
 $36.50
Dime-a-Day
 $50
Women in
Optimism
 $100
Century Circle
RESTRICTED GIFT
 $ ________________________
Outsourcing Project
 $250
 $500
 $1 000
Presidents' Club Friends of Today Christian D.
Larson Partners
$_________
Other amount
Project number : __________________________________________
 IN MEMORIAM
 IN HONOR
I need a  NAME PATCH | minimum of $100 donation for a name batch
 CCOF BANNER PATCH
THIS DONATION IS
Deceased person: ____________________________________________________________________________________________
Person to notify: _____________________________________________________________________________________________
Address: _________________________________________________________________________________________________
Person who will receive the patch: _______________________________________________________________________________
Address: _________________________________________________________________________________________________
3. CHOOSE A PAYMENT METHOD
 Enclosed is a cheque made out to the Canadian Children’s Optimist Foundation


CVV Code: __________________ Expiry Date: __________________
(last 3 digits on the back of your card)
( MM
/
DD
/
YY )
Visit us on ccof-foec.org
5205 Metropolitain Blvd. E., suite 200, Montreal, Quebec H1R 1Z7
Tel: 1-800-363-7151 | 514-593-4401 poste : 336
Fax: 514-721-1104 [email protected]