“Helping us promote a new perspective on disability”

DONATION FORM

Donor Information

Name: _____________________________________________

Address: ___________________________________________

Tel: No. ____________________________________________

E-Mail: _____________________________________________

Contribution

I want to support Canadians living with a disability with a donation, payable to Independent Living Canada in the amount of:

$25___ $50___ $75____ $100____ Other _______

Thank you for your generosity!

_____ I would like to leave a gift in my Will to Independent Living Canada

Please complete mail to:

Independent Living Canada
Financial Officer
214 Montreal Road, Suite 402 (July 27th, 2009)
Ottawa ON Canada  K1L 8L8

Tax Receipts

An official receipt for income tax purposes will be issued for all donations of $20.00 and more.

For enquiries, please call:

(613) 563-2581, Ext. 20

DONATION FORM - download