Donation Form

Sooke Hospice Society

Please print out this form, complete it and return it to us

YOUR NAME ______________________________________________

ADDRESS _________________________________________________

CITY _____________________________________________________

PROVINCE _____________________ POSTAL CODE_______ ______

DAY PHONE ___________________ EVE PHONE _______________

Enclosed is my cheque, made payable to Sooke Hospice
in the amount of ____________________

I would like to make my gift - In Memory of ______ or in Honour of ______

Name of Person:_____________________________________________

Please send a notification card to let the family / person know of my
memorial/honorarium gift to:
NAME ______________________________________________

ADDRESS _________________________________________________

CITY _____________________________________________________

PROVINCE _____________________ POSTAL CODE_______ ______

Relationship to the deceased ____________________________________

I would like a charitable donation receipt ____ yes or ____ no

Mail to: Sooke Hospice
PO Box 731, Sooke, BC, V9Z 1H7
Or phone for pick up:
Phone (250) 642-4345 or Fax (250) 642-0232