1. Gilda’s Givers: A Monthly Giving Club
So that no one faces cancer alone.TM
YES, I would like to become a Gilda’s Giver and make a monthly donation to Gilda’s Club.
$_________ a month, so that no one
faces cancer alone.
$11 every month, to fund one person’s participation
in a weekly support group.
$18.50 every month, to cover the cost of one child participating in the full program for children, youth and families.
$47.55 every month, to fund one person’s full
participation in our emotional and social support program.
Method of Gift Payment:
Pre-authorized debit from my account (please include a VOID cheque with this form)
VISA  MasterCard  AMEX:
Card Number _________________________________ Expiry Date ___/___
Please process my donation on the  1st or the  15th of every month.
Signature:_____________________________________________________ Date: ______________
Name(s)
Organization (if applicable)
Address
City, Prov, Postal Code
Telephone
Gilda’s Club Simcoe Muskoka is a registered charity (Registration# RR0001) and we respect the privacy of our donors. Information collected will be used to issue receipts and to inform you about Gilda’s Club activities, news and events.
Please send your completed form by mail, fax or to:
Gilda’s Club Simcoe Muskoka, 10 Quarry Ridge Rd., Barrie, ON L4M 7G1
Tel: Fax:
You may cancel your monthly donation at any time, with a notice of 15 business days. Simply phone us at the number above.
For more information about cancelling pre-authorized donation please contact your financial institution or visit