Name (required): Address (required): City (required): Province (required): Postal Code (required): Phone Number (required): Email (required): I/we wish to join Friends of the Foundation and support NBRHC Foundation through monthly donation of (required):---$10$20$25$30 ($1 a day)$50$83.33 ($1,000 per yr)Other Amount If other, please specify the monthly amount: This donation is made on behalf of (required):---an Individuala business Payment method (required):---Bank AccountCredit CardPostdated Cheques *Please Note:
Please designate my gift to (required):---Greatest Need FundOther If other, please specify: I would like my name to appear as (required): on published donor recognition lists. Today's date (required): I acknowledge my intent to participate in the Monthly Giving Donation Program with the NBRHC Foundation.---Yes Foundation donor list and donor wall recognition:---As an inspiration to others, I agree to allow my name to be added to the Foundation donor list and donor wall.I wish my name to remain anonymous. (Your name will not be added to any donor list).
CHARITABLE NO. # 88773 1123 RR0001
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50 College Drive, P.O. Box 2500 North Bay, ON P1B 5A4 Tel: 705-474-8600
680 Kirkwood Drive, Sudbury, ON P3E 1X3 Tel: 705-675-9193 Fax: 705-675-6817
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