Adopt-an-Acre On-line form

ADOPT-AN-ACRE
Mail-in Donation Form

Directions: Use the PRINT command in your browser to print out this form. Complete the information as you wish it to appear on the certificate and correspondence. Place the form, along with a cheque in the amount of your pledge, into an envelope and mail it to the address below.

A charitable receipt will be issued in the amount of the donation and a certificate and window decal will be sent to the donor.

This form is also available in an On-line version, which you can SUBMIT to the LRCA.

Yes, I (we) want to be part of the Adopt-an-acre program!

Donor information:

Name: _____________________________________________________

Address:
_____________________________________________________

City:
_________________________   Prov.: ____ Postal Code: __________

Phone: (optional)
_____________________________________________________

Wording on Certificate

Donation from: _____________________________________________________

OPTIONS:

On behalf of: _____________________________________________________

In memory of:
_____________________________________________________

DONATION AMOUNT

# of Acres: _____________

@ $25 per acre

Total Gift = $ _____________

[  ] Yes, I wish to be a Sustaining Conservationist ($500 one-time donation for one acre)
Attach a cheque in the amount of your pledge, payable to the Lakehead Region Conservation Authority, and mail to:

Adopt-an-Acre
Lakehead Region Conservation Authority
P.O. Box 10427
Thunder Bay, ON   P7B 6T8

~ Thank you for being a part of Adopt-an-Acre ~

Use the PRINT command in your browser to print out the blank form.

Return to Adopt-an-Acre page.

Go to Adopt-an-Acre On-line form.

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

Donor information:
Name:	_____________________________________________________
Address:	_____________________________________________________
City:	_________________________ Prov.: ____ Postal Code: __________
Phone: (optional)	_____________________________________________________
Wording on Certificate
Donation from:	_____________________________________________________
OPTIONS:
On behalf of:	_____________________________________________________
In memory of:	_____________________________________________________
DONATION AMOUNT
# of Acres:	_____________
@ $25 per acre
Total Gift = $	_____________
[ ] Yes, I wish to be a Sustaining Conservationist ($500 one-time donation for one acre) Attach a cheque in the amount of your pledge, payable to the Lakehead Region Conservation Authority, and mail to: Adopt-an-Acre Lakehead Region Conservation Authority P.O. Box 10427 Thunder Bay, ON P7B 6T8 ~ Thank you for being a part of Adopt-an-Acre ~