|
|
|
|
| Full Name: |
|
| Address: |
|
| City: |
|
| Postal Code: |
|
| Phone Number: |
|
| Fax Number: |
|
| E-mail Address: |
|
| You may choose to submit electronically or you can print the form and mail it in with your donation. Please make cheques payable to Belwood Lodge & Camp. | |
| Charitable Number: 118803154 RR 0001 | |