Printable Form

Tickets for Trudeau's Legacy in Obama's World

December 3rd, 2008

 

 

I would like to purchase __________ tickets at $75 per ticket.
Total cost $____________.00
Name: ____________________________________________________________________

Street Address: _____________________________________________________________

City: _____________________________________________________________________

Province: ________________________________ Postal Code: _______________________

Phone number: ______________________________________________________________

Email address: ______________________________________________________________

 

Enclosed please find a cheque for $______________.00

or bill $________________.00 to my VISA MASTERCARD AMEX

Credit Card Number: _________________________________________________________

Expiry Date: _______________________

Name (as it appears on card): __________________________________________________

Signature: _________________________________________________________________

Canadian Landmine Foundation, 1623 Yonge Street, Toronto, Ontario M4T 2A1.
FAX: 416-365-7019

A tax receipt will be issued for $55.00

Charitable Number: 866765423 RR0001

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