Thank you!

Yes! I would like to make a donation in support of Wordplay TAP!

Name: Address: Phone:

Spouse: Email:

SINGLE GIFT

My gift of:

$20 $50 $100 I prefer to give $______

MONTHLY GIFT

I would like to join the iGive Monthly Club with a monthly gift of:

$10/month

$15/month

$20/month

$25/month

Other $______ /month

I authorize the NBRHC Foundation to debit my bank account each month (void cheque enclosed), deduct my gift through payroll or charge my credit card each month.

My cheque to North Bay Regional Health Centre Foundation is enclosed. Please charge my donation to my credit card:

Card number:

Expiry Date:

Signature:

Name on Card:

Thank you!

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