Norwich Save a Life Fund Donation Form

Norwich Save A Life Fund
Donation Form

Donor's Name:________________________________________________________

Donor's Address:_______________________________________________________

_____________________________________________________________________

Donor's Phone Number:_________________________________________________

Donation Made in Honour of:_____________________________________________

Or Donation Made in Memory of:_________________________________________

Total Enclosed:________________________________________________________

Is A Tax Receipt Required? (Please Circle Yes or No). YES / NO

White bulbs are lit in memory or a loved one.
Coloured bulbs are lit in honour of a living individual.
Offical Income Tax Receipts Available for amounts of $10.00 and over. Please make cheques payable to Tree of Life or Save A Life Fund. Forms can be mailed to Norwich Save A Life a Fund, c/o Norwich Gazette, P.O. Box 459 Norwich, Ontario, Canada, N0J 1P0.

The Norwich Gazette will publish the names of individuals who have had lights dedicated to them.

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