Pledge Form

The Heart and Stroke Foundation of BC & Yukon
1-947 Fort Street,
Victoria, BC V8V 3K3

Tel: (250) 382-4035
Official
Pledge
Charity

Sunday, April 28, 2002
Name: I would like to be a Heart and Stroke Volunteer
Team Name: Phone (H):
Address: Phone (W)
Team Captain: Fax
City: Postal Code: E-Mail:
By Collecting pledges, you can earn terrific prizes!
SPONSOR'S NAME
ADDRESS
CITY/PROV
POSTAL
CODE
RECEIPT
REQ'D
$
COLLECTED
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
Pledges must be submitted by 8am April 28 to be eligible for awards.
Tax receipts will be issued for $10 or more. DO NOT MAIL CASH!
Please makes cheques payable to: The Heart and Stroke Foundation
TOTAL