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Phone Number (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 designate my gift to (required):---Greatest Need FundOther
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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
50 College Drive,
P.O. Box 2500
North Bay, ON
680 Kirkwood Drive,
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