D o n o r  Form Print and fill out this form

Shop the Trail ------ For more information:  email: info@tctrail.ca   •   toll free phone: 1-800-465-3636   •  Southwest phone: (604) 942-6768

Donor Name ________________________________________________________________

Donor Address _____________________________________________________________________________

City ________________________________________Province ______________________________

Postal Code _____________________Phone Number _________________ E-mail ___________________________________

Name to be put on Panel - maximum 25 characters including spaces (If you are contributing to more than one metre, please print addtional names on separate pages.)

Last Name first ______________________________________________________________

Place in Canada where you wish the name to appear _________________________________________________

Address where certificate will be sent - if different from donor's. All receipts will be automatically sent to donor.

Address____________________________________________________________________________________

City _____________________________________ Province ______________________________

Postal Code _____________________ Phone Number _________________

Materials to be sent in: English _____ French ______

Is this donation in memory of a departed loved one? Yes _____No _____

Donation made by: CHEQUE ___ (Payable to 'The Trans Canada Trail Foundation')

VISA ___ MASTERCARD ___CARD NUMBER __________________________________________

EXPIRY DATE ___________SIGNATURE_________________________________________
Send to: Trans Canada Trail Foundation, 43 Westminster Ave. N., Montreal West, Quebec H4X 1Y8 -- Fax: (514) 485-4541