pledge form

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Page:________of:__________
ARCH Hospice Fundraising Form
Please consider providing an email. Email receipts will help us allocate more funds to providing quality compassionate care through end-of-life.
First Name:___________________________ Last Name:_________________________ Team:______________________________
Address:_______________________________ Apt:_____ City:____________________ Province:____ Postal Code:___________
Email:______________________________________________________________
First Name
Last Name
1
Email Address:
2
Email Address:
3
Email Address:
4
Email Address:
5
Email Address:
6
Email Address:
7
Email Address:
8
Email Address:
9
Email Address:
10
Email Address:
RAISE $100
PER HIKER TO
RECEIVE A
T-SHIRT!
Please provide me with an email tax receipt
Home Tel:____________________________ Bus Tel:____________________________EOther Tel:___________________________
Receipts will be issued for all donations of $20 or more, or if requested, only if donors name
v and address are complete and legible.
Please make cheques payable to “ARCH”. ARCH Hospice 229 Fourth Line West, Sault Ste. Marie, Ontario P6A 0B5
e
Receipt
Home Address
City
Prov. Postal Code
Office Use
Type
Amount
n
Cheque
Yes
t
Cash
No
L
Cheque
Yes
o
Cash
No
g
Cheque
Yes
o
Cash
No
&
Cheque
Yes
I
Cash
No
n
Cheque
Yes
f
Cash
No
o
Cheque
Yes
r
Cash
No
m
Cheque
Yes
a
Cash
No
t
Cheque
Yes
i
Cash
No
o
Cheque
Yes
n
RAISE $150
PER HIKER TO
RECEIVE A
T-SHIRT &
TUMBLER!
REGISTRATION IN PLEDGES $25 PER HIKER – RECEIVE A MEMORY TAG
By signing this form, I hereby remise, release and forever discharge ARCH
Hospice, RBC Royal Bank and any other organizers, sponsors, staff, volunteers,
and participants of and from any liability associated with the annual Hike for
Hospice. It is expressly understood and agreed that there are risks with
voluntary participation in The Hike. It is further expressed and understood that
hiking can be dangerous and that, by participating in the Hike for Hospice I am
placing myself at risk of injury. I therefore agree to assume all risks of every
kind and nature whatsoever arising out of my participation in the Hike for
Hospice. I further acknowledge that my participation and attendance at or
during the Hike for Hospice constitutes permission to be photographed for
possible publicity, promotional, or other purposes, and constitutes a waiver of
any and all claims for compensation from all sponsoring agencies.
_________________________________
Participant’s Signature
______________________
Date
Cash
No
Cheque
Yes
Cash
No
Total Cash
$_______________________
Total Cheque
$_______________________
Total Page
$_______________________
FOR OFFICE USE ONLY
Receipted
$_______________________
Non Receipted $_______________________
Total Collected $_______________________
Registered Charity # 86395 3766 RR0001
FD.02