Blank Calgary Form

Document Sample
Blank Calgary Form Powered By Docstoc
					 Membership or Donation                                                           United Nations Association
                                                                                          in Canada
   - Calgary Branch -                                                               Charitable Registration No. 11927-6855 RR0001


Surname                                                                Given Name(s)
Address                                                                                               Apt No
City                                                                   Prov.                    Postal Code
Title (Mr., Mrs., Ms., Dr. etc.)                                       Home Telephone (opt.) (              )
Fax (opt.)      (       )                                              Work Telephone (opt.) (              )
Email (opt.) (please print clearly)

 I would like to receive information from my local Branch on the activities organized in my community.
       (Please provide email)

 I would like to receive email updates (4-6/year) on UNA-Canada national activities from the national office.
       (Please provide email)

 Please do not trade or share my name with other organizations.
 This is a one-time gift. Please do not add me to UNA-Canada’s mailing list.

                                                 My Gift Information…

I would like to make a gift of:                        A charitable tax receipt will be issued for gifts of $10.00 or more
        $25             $35             $50             $100             $200            I prefer to give $
I prefer to pay by:
 Cash                                   Please see over for American Express & monthly giving payment options 

 Cheque or money order made payable to either “United Nations Association in Canada” or “UNA-Canada”
 Credit card. UNA-Canada accepts:                     VISA®         MasterCard®
       Card Number                                                                      Expiry Date
       Name as it appears on card (please print clearly)

I would like to designate my gift as follows (please choose only one option):
 MEMBERSHIP (become a member both locally & nationally in one step)
 DONATION to UNA-Canada’s Calgary Branch (100% goes to Branch, NOT membership)
       Please do NOT make a cheque out to the Branch. All gifts are processed at the national office. After processing your
       charitable receipt, the national office will forward 100% of your gift to the Branch.

                                                                                                                          … / page 2
           American Express Payment Option (Available On-Line ONLY)

American Express is an available payment option but only on UNA-Canada’s secure on-line giving website,
managed by CanadaHelps. The site will provide a drop-down gift designation option of membership or donation
to a Branch - it appears a few steps into the process. Your credit card donation is forwarded within 3 working
days to UNA-Canada’s bank account. A charitable receipt will be emailed to you directly by CanadaHelps within
a few minutes of your donation. To get to UNA-Canada’s on-line giving webpage on CanadaHelps…
 Go to UNA-Canada’s website at and click on the “Donate/Join OnLine” button at the top right.

                AMBASSADOR’S CIRCLE: Monthly Giving Payment Option

                       Many of our supporters have asked how they can help the most.
                  UNA-Canada’s “Ambassador’s Circle” monthly giving programme is the answer.
Monthly pre-authorized donations are convenient and help reduce costs so your donation goes further.
  Even a small amount each month adds up to a significant commitment over the course of a year.

Authorization for Monthly Withdrawal
I understand that the amount I indicate below will be deducted from my bank account or credit card
automatically on the first working day of each month. I know I can alter or cancel this plan at any time by
contacting UNA-Canada. A charitable tax receipt for the total amount donated through the Ambassador’s Circle
programme during any given year will be mailed to me in late January or early February of the following year.
YES, I authorize the United Nations Association in Canada to make monthly withdrawals of:
     $5              $10           $15            $25            I am able to give $             /month
    Signature                                                       Today’s Date

Payment Method
Please take my monthly contribution from:
 My chequing account. I have enclosed a blank cheque marked “VOID”.
 My credit card account. I prefer to use my:        VISA®          MasterCard®
    Card Number                                                          Expiry Date
    Name as it appears on card

                Questions? … Comments? … Where to send your gift …

We are always happy to hear from Canadians who are interested in UNA-Canada.

Calgary Branch:              Rida Abboud, President 
                           PO Box 6593 Stn D, Calgary, AB T2Z 2M3

Please send your membership/donation to the National Office at the following address :
(All membership, charitable gifts and receipts are processed at the National Office. Funds and names are then
forwarded to Branches.)

UNA-Canada, 309 Cooper St., Suite 300, Ottawa, ON K2P 0G5
Email:     Tel: (613) 232-5751 ext 228                Fax: (613) 563-2455

                               Thank you so much for your support!

Shared By:
Description: Blank Calgary Form document sample