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Laurel Packinghouse Heritage Fund Cheque Donation Form

Use this form if you are mailing in a donation by cheque. Complete all areas, print the form, and mail
to the address at the bottom of the form.

I have enclosed a cheque in the amount of $____________ made payable to the

KELOWNA MUSEUMS SOCIETY

Please send a charitable tax receipt to: (for gifts $10.00 and over)

Name: _______________________________________________________

Address: _____________________________________________________

City/ Town: _________________ Province: ______ Postal Code: ________

Telephone: __________________ Email: ___________________________

Gifts in Special Recognition

This gift is: In Memory of To Honour

Name: ____________________________________________

If you wish a card to be sent on your behalf: (your name only is given)

Name of next of kin/ honouree: ____________________________________

Address: ______________________________________________________

City/ Town: _________________ Province: ______ Postal Code: ________

Your personal information and gift amount is held in the strictest confidence unless you instruct otherwise. May
we include your name only in our Recognition Program? Yes No

THANK YOU FOR YOUR GIFT!

Mail to: Kelowna Museums Society

470 Queensway Avenue
Kelowna, BC, V1Y 6S7

Charitable Tax # 11897 8626 RR0001

Phone: 250-763-2417
LaurelPackinghouse.ca