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The Terry Fox Foundation Donation Form Name: All donations of $20 or more will automatically be sent a tax Address: receipt. Gifts under $20 can request a receipt. City/Town: THANK YOU FOR YOUR SUPPORT! Province: Please mail this form to your provincial office or fax to the number provided. Postal Code: British Columbia / Yukon Territory Phone: ( ) 2669 Shaughnessy Street Port Coquitlam, British Columbia V3C 3G7 Email: Tel: 604 464-2666 Fax: 604 464-2664 Alberta / Northwest Territories / Nunavut DONATION: $ Suite D 10 - 6115, 3rd St SE Calgary, Alberta T2H 2L2 Tel: 403 212-1336 Fax: 403 212-1343 Please make my gift in memory of: Saskatchewan 2001 Cornwall Street, Suite 116 Regina, Saskatchewan S4P 3X9 Please make my gift in tribute to: Tel: 306 757-1662 Fax: 306 757-7422 Manitoba Personal Message: 543 St Mary's Rd Winnipeg, Manitoba R2M 3L4 Tel: 204 231-5282 Fax: 204 231-5365 Ontario Suite 804, 789 Don Mills Rd Toronto, Ontario M3C 1T5 Please notify the family of this gift: Tel: 416 924-8252 Fax: 416 924-6597 Name: Quebec Suite 518, 1117 St. Catherine St. West Address: Montreal, Quebec H3B 1H9 Tel: 514 499-9747 Fax: 514 499-9924 City/Town: New Brunswick / Prince Edward Island 517 Northumberland St. Province: Fredericton, NB E3B 3K7 Tel: 506 458-2618 Fax: 506 459-4572 Postal Code: Nova Scotia Suite 435, 1657 Barrington St I have enclosed a cheque payable to The Terry Halifax, Nova Scotia B3J 2A1 Fox Foundation Tel: 902 423-8131 Fax: 902 492-3639 Please charge this donation to a credit card Newfoundland and Labrador 835 Topsail Rd., Suite 202, Mt. Pearl, Newfoundland and Labrador A1N 3J6 VISA MasterCard AMEX Tel: 709 576-8428 Fax: 709 747-7277 Card #: Expiry (mm/yy): / CVV: Please call toll free 1-888-836-9786 with any questions or if you would like to learn Name on Card: more about the Foundation or The Terry Fox Signature: Run.
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