Instructions for Pledge Forms

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                           Instructions
for
Pledge
Forms

                                                         

    Please
ensure
that
all
donations
are
submitted
with
this
form.
Mail
or
drop
off
the
forms
and
donations
to:

                                           Saskatchewan
Cancer
Agency

                                              204‐3775
Pasqua
Street

                                                Regina,
SK
S4S
6W8

                                                          

                                                          

                                              Head
Shaving
Donation
Form

                     Proceeds
going
towards
breast
cancer
research
and
patient
comfort

                                                                      


                     

Name
of
organization
(if
applicable):
__________________________________________________


                  

Name
of
“Shavee”:
_____________________________________________________________________

































Name
of
person
collecting
donations
(contact
person):________________________________________


                  

Contact
person’s
phone
number:__________________________________________________________


    First
and
Last
Name
               Address
                       City
and
Postal
Code
             Phone
        Amount
    Cash
   Cheque

**Please
Print
Clearly**
                                                                              Number
        Donated
    
       


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 


                           
                                   
                                  
                 $

                                                                                                                                 
 

                                             ********
Please
make
cheques
payable
to
SCA*********


     
*************Donations
of
$10
and
more
will
receive
a
tax
receipt;
please
ensure
donor’s
name/address
is
clear
and
complete**********

     First
and
Last
Name
                Address
                  City
and
Postal
Code
           Phone
       Amount
     Cash
 Cheque

    **Please
Print
Clearly**
                                                                     Number
       Donated
     
     


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 


                               
                             
                               

                                                                                                              $
            
 

                                           ********
Please
make
cheques
payable
to
SCA*********


    *************Donations
of
$10
and
more
will
receive
a
tax
receipt;
please
ensure
donor’s
name/address
is
clear
and
complete**********