Relay for Life Donation Form - Canada

By providing this information you consent for the Canadian
Cancer Society (CCS) to collect, disclose, and use it for
follow-up contacts, statistical purposes, and to process and
recognize donations. Information will be disclosed to
employees and agents of CCS as necessary to accomplish
these purposes. Name, and contact information are
optional. If you do not wish to be identified please enter
“Anonymous” for both the first and last name. Tax receipts
cannot be issued to ananymous donors. If you have any
questions please contact Donor Relations at 1-888-700-1131.
To view our complete privacy policy visit www.cancer.ca and
click on the Privacy link at the bottom of our home page.
*
Canadian Cancer Society Relay For Life Donation Form
For cash & cheque donations
cheques payable to “Canadian Cancer Society”
FOR CANADIAN CANCER SOCIETY USE
FOR CANADIAN CANCER SOCIETY USE
ADDITIONAL FUNDS
SHEET TOTAL
$
$
PARTICIPANT INFORMATION –
Please complete name and address on each donation sheet.
ADDITIONAL FUNDS –
Coin box, team fundraising, donations not requiring a receipt.
EVENT LOCATION:
Date:
Team Name My Goal is $ Return Form to:
First Name Last Name
Suite/Apt# Address City Prov
Postal Code Email Phone
( )
RETURNING DONATION FORMS AND MONEY
a. Check your online event schedule for local cutoff dates at:
www.cancer.ca/relay or contact your team captain
TAX RECEIPT INFORMATION
• Donations of $25 or more will receive a tax receipt via mail.
• Charitable #11882 9803 RR0002 (Canada); 98-6001242 (USA)
• Receipts will be issued in the fall. If you have not received your receipt by December 31, please contact Donor Relations at 1-888-700-1131
DONATION INFORMATION –
Donor’s name and address MUST be complete and legible to receive a tax receipt.
DONATION AMOUNT
MANDATORY
Under $25
Receipt Requested
1
( )
First Name Last Name
Suite/Apt# Address City
Prov Postal Code Phone
Cash Cheque
Mr Mrs Ms Dr
2
3
4
5
Under $25
Receipt Requested
Under $25
Receipt Requested
Under $25
Receipt Requested
Under $25
Receipt Requested
(anonymous, do not include Gaming, Luminaries, registration)
Cash Amount Total
Cheque Amount Total
Total Donations Collected
CCS Person (Verified By: )
Information entered into Kintera Initial
Verified
Verified
Verified
BOX 1
DEPOSIT “SLIP” #: 0
CODE: _____ _____ _____ _____ _____ 5460 102
Region Unit
DATE DEPOSITED:
Depositor’s Name ( Please print first and last name):
BOX 2 - MANDATORY
( )
First Name Last Name
Suite/Apt# Address City
Prov Postal Code Phone
Cash Cheque
Mr Mrs Ms Dr
( )
First Name Last Name
Suite/Apt# Address City
Prov Postal Code Phone
Cash Cheque
Mr Mrs Ms Dr
( )
First Name Last Name
Suite/Apt# Address City
Prov Postal Code Phone
Cash Cheque
Mr Mrs Ms Dr
( )
First Name Last Name
Suite/Apt# Address City
Prov Postal Code Phone
Cash Cheque
Mr Mrs Ms Dr
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