Donation Form
Sooke Hospice Society

Our Promise to You:
Sooke Hospice respects your privacy. We do not lend or sell any of your personal information. We never lend or exchange lists with other agencies. You have our word!

Please print out this form, complete it and return it to us

YOUR NAME: ______________________________________________

ADDRESS _________________________________________________

CITY _____________________________________________________

PROVINCE _____________________ POSTAL CODE_______ ______

DAY PHONE: ___________________ EVE PHONE _______________

Enclosed is my cheque, made payable to Sooke Hospice
in the amount of: ____________________

I would like t make my gift - In Memory of ______ or in Honour of ______

Name of Person:_____________________________________________

Please send a notification card to let the family / person know of my memorial/honorarium gift to:
NAME: ______________________________________________

ADDRESS _________________________________________________

CITY _____________________________________________________

PROVINCE _____________________ POSTAL CODE_______ ______

Relationship to the deceased ____________________________________

I would like a charitable donation receipt ____ yes or ____ no

Mail to: Sooke Hospice
PO Box 731, Sooke, BC, V0S 1N0
Or phone for pick up:
Phone (250) 642-4345 or Fax (250) 642-0232