Your Hospital Foundation...building a HEALTHIER FUTURE We invite you to make a donation to the CHC Foundation. Your donation is tax deductible to the full extent provided by Revenue Canada. All donations and pledges of $1,000 will be permanently engraved on the donor recognition wall at the new hospital. Donations are cumulative. Name: ______________________________________________ Address: ____________________________________________ ____________________________________________________ Postal Code: __________________ My/our gift to the Foundation is: $10 _____ $35 _____ $50 _____ $100 _____ Other __________ A cheque in the amount of $ _________________ is enclosed. I/We prefer to use Visa. VISA # _______________________________________________ Expiry Date: ___________________________________________ Signature: _____________________________________________ I would like to use these funds to support: Urgently needed medical equipment The Foundation Endowment Fund Mail To Cumberland Health Care Foundation 19428 Hwy.2, R.R. 6 Amherst, Nova Scotia Canada, B4H 1N6 Thank you for your support!