The Safety City Society of Lethbridge Donation Form

Name: ______________________________________________________
Address: ____________________________________________________
City: ___________________________ Postal Code: __________________
Phone: __________________________ Fax: ________________________
Contact Person: _______________________________________________
Email: ______________________________________________________

A. One time donation in the amount of _________________.
B. Donation to the Endowment Fund of _________________.
C. Annual pledge in the amount of _____________ per year, beginning
(month) _____ of (year) _____. I will honor this pledge for the next ____ years.
D. Program sponsorship for the (program title) ________________ for the ____ school year.
E. Donation to the capital building project in the amount of ________________.
F. Donation of goods and/or services to the capital project with a value of __________.
Description: __________________________________________________________
____________________________________________________________________
____________________________________________________________________

_____ I would like to purchase a membership in the Safety City Society of Lethbridge at a
cost of $25 per year. I will receive the Safety City Siren (quarterly newsletter), as well as
an invitation to the Annual General Meeting.

Date: __________
Signature: _____________________________________________

Note: Safety City will post the names of all contributors permanently at the Safety City Training Centre and on our web site. By giving a donation, you will be considered a member of the Safety City Society of Lethbridge, which entitles you to receive the Safety City Siren (quarterly newsletter), as well as an invitation to attend the Annual General Meeting.