Reply to Lakehead Conservation Foundation

Lakehead Conservation Foundation
RESPONSE FORM

DINNER TICKETS

Send me tickets to the Lakehead Conservation Foundation's Fundraising Dinner & Auction on Feb. 12, 2004 at the Valhalla Inn.

# of Tickets: ________ @ $50 per ticket

= $________

BE A FRIEND
	I want to become a 'Friend of the Foundation' at a cost of $25 for a one-year membership.

= $________

I wish to make a charitable donation of

= $________

MEMORIAL GROVE DONATION
	I want to make a MEMORIAL GROVE TREE DONATION. One tree will be planted for a $45 donation. Please enter the particulars below. A tax receipt and certificate will be issued.

= $________

Wording
on
Certificate

In memory of: ____________________________________

Donation from: ___________________________________

Send
Certificate
to:

Same as
receipt
(see below)

Name: _____________________________________

Address: _____________________________________

City:_______________________ Prov.:______

Postal Code:_____________

PAYMENT
	I have enclosed a cheque for the amount at right, made payable to the Lakehead Conservation Foundation
	I wish to charge the above amount to my VISA card.

= $________
TOTAL
AMOUNT

Card#: _________________________________ Expiry:____________

Cardholders Name: __________________________________________

Cardholders Signature: _______________________________________


MAILING INFORMATION FOR RECEIPT:
Name:	________________________________________________________
Address:	________________________________________________________
City:	_________________________ Prov.: _____ Postal Code: __________
Phone: (optional)	________________________________________________________


	Please put this form with your gift in an envelope and mail to: Lakehead Conservation Foundation P.O. Box 10147 Thunder Bay, ON P7B 6T6			Please send information about ________________________ ________________________

Go to Lakehead Conservation Foundation page in the 2003 LRCA Annual Report

Lakehead Region Conservation Authority
P.O. Box 10427; 130 Conservation Rd.
Thunder Bay, ON P7B 6T8 (Canada)
Telephone:(807) 344-5857 Fax:(807) 345-9156


	CONTENTS 2003 ANNUAL REPORT
Erosion \| Aquifer Study \| Floodway \| Groundwater \| Reflections \| Development Review \| Watershed Report \| Employment \| About Us \| Members & Staff \| Financial \| Foundation \| Events 2004 \| Explore \| News Items \| Explorer Card \| Memorial Grove \| Hazelwood Lake Centre