Nanaimo Child Development Centre :: Silly Boat Regatta Donation Form

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Type of Donation

Type:

Sponsor or Team Name:

Contact & Receipt Information

Your Email Address:

Title:

First Name:

Last Name:

Address:

Address2:

City:

Prov/St:

Postal/Zip Code:

Phone:

Donation Information

Donation Amount:

Credit Card Type:

Credit Card #:

- - -

Name on Card:

Expiry Date:

Receipt Request

Receipt Required:

Do you require a Giving Certificate? Please let us know the name you would like on it:

Yes, I would like to receive email updates from the Child Development Centre