Everywoman's Health Centre Donation Form

Donation Amount:

Hollyhock Member $500
Friend of the Clinic Member $250
Sustaining Member $100
Caravan Member $75
Supporting Member $50
first name
last name
postal code
phone number
email address
donation amount
type (circle)CASH-CHEQUE-PAC*

*PAC Donor
Pre-Authorized Contribution
Monthly donation from your bank account
Send voided cheque with this form

Send to EHC at:
210 2525 Commercial Drive
Vancouver, BC
V5N 4C1

Everywoman's Health Centre - www.everywomanshealthcentre.ca