Gift Certificate Form

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CAROLINIAN CANADA ON-LINE GIFT DONATION FORM

Please complete all fields below.

A Gift From:

First Name:
Last Name:
Group:
Address:
City:
Province:
Postal Code:
Email:
Phone:

A Gift To:

First Name:
Last Name:
Group:
Address:
City:
Province:
Postal Code:
Email:
Phone:

Choose your Gift Donation Package:

$140 Big Picture Core Protector
$90 Landscape Connector
$60 Habitat Steward
$30 Seed Planter
$20 Welcome to Carolinian Canada
Carolinian Canada Explorer

Enter dollar amount of "Explorer" gift certificate. We'll apply to the receiver's account:

$

Payment Options:

Cheque (After submitting this form, please print the next page, which displays your entries, and mail with your cheque to Carolinian Canada.)

We are currently unable to accept donations by credit card. We apologize for the inconvenience.

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