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To support the work of the Canadian Landmine Foundation you can count on me for a monthly tax-deductible gift of:

$10 $20 $40 Other $ ___________
 
Name: _______________________________________________________________________

Street Address: ________________________________________________________________

City: _________________________________________________________________

Province: ___________________________________ Postal Code: _______________________

Email address: ________________________________________________________________

OPTION #1: I'd like to make my monthly gift from my chequing account. I've enclosed a sample cheque marked "void", to give you the information necessary to make the automatic withdrawals. I prefer to give my gift on the __________ of the month.

OPTION #2: I prefer to make my monthly gift through my:

VISA MASTERCARD AMEX

Credit Card Number: ____________________________________________________________

Expiry Date: _______________________

Name (as it appears on card): _____________________________________________________

Signature: ________________________________________________

OPTION #3: Sorry, I cannot make a monthly commitment at this time, but enclose a special one-time gift of $ ______________________

GUARANTEE: You may change or cancel your monthly donation at any time by calling us at 416-365-9461.

Canadian Landmine Foundation, 1623 Yonge Street, Toronto, Ontario M4T 2A1. Email:info@canadianlandmine.org

Charitable Number: 866765423 RR0001

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