Park Alert - Earthroots - Donation Form

YES! I WANT TO HELP PROTECT WILDERNESS & WILDLIFE!
Please mail this form with appropriate payment method to Earthroots at: 401 Richmond St. West , Suite 410 Toronto, Ontario, M5V 3A8
Here's my donation of:	$50 $75 $100 $200
	I would prefer to give $_________

Name	___________________________
Address	___________________________
Province	___________________________
Postal Code	___________________________
Telephone#	___________________________
E-Mail Address	___________________________
Please Check One:

I have enclosed my cheque
I prefer to pay by VISA MasterCard
Card #	___________________________
Expiry	___________________________
Signature	___________________________
I would like to be a Sustaining Donor and give monthly. Please see below.

I want my donation to go to action and lobbying campaigns. I understand this contribution is not tax deductible.
[Earthroots Coalition]

I require a tax receipt and want my donation to go to public education and research.
[Earthroots Fund (charitable registration #135165140 RR0001)].

"Sustaining Donor"

This is a special group of Earthroots supporters dedicated to protecting threatened wilderness and wildlife by providing monthly support for our campaigns. As a year round supporter, you'll help us cut administrative and fundraising costs while reducing our use of paper! You may change or cancel your monthly donation any time by calling the Earthroots office at (416) 599-0152.

Please deduct a monthly contribution of:	$10 $15 $20 $30 ($1 a day!) Other $_________
I will make these contributions from my:	Chequing Account I have enclosed a VOID cheque
	VISA MasterCard Please fill in card information above.

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