r YES! I would like to support patient care in my community.
City: Province: Postal Code:
Telephone: Fax: E-Mail:
r I prefer to give $____________
r My cheque/money order is enclosed, made payable to: Lambton Hospitals Foundation
r I prefer to use my: r VISA r Mastercard
Expiry Date: Cardholder’s Signature:
Please direct my gift to:
r Priority Needs
r I prefer to direct my donation to: (your program/department of choice)
r Please send me information on making a gift in my will.
r Please send me information on making a monthly donation.
Please fax this form to Lambton Hospitals
Foundation at (519) 336-8780.
Or mail this form along with your cheque or money order to:
Lambton Hospitals Foundation
89 Norman Street, Sarnia, ON, N7T 6S3
For more information, please call (519) 464-4408 or email [email protected].
Charitable Business Number: 86939 4163 RR0001
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