I Want to Spread My Gift Giving Over the Year

CWGHR

1240 Bay Street

Suite 600

Toronto, ON M5R 2A7

416-513-0440

www.hivandrehab.ca

I would like to donate a Tribute Gift

Your gift helps fund unique, leading-edge rehabilitation projects that reach people living with HIV and other episodic disabilities, and their friends, family and caregivers.

Donor Name

Home Address

City/Prov/Postal Code

Telephone: ( )

Please accept my donation of:

 $20  $50  $100  $200  $500  Other $______

I have enclosed a cheque payable to Canadian Working Group on HIV and Rehabilitation (CWGHR)

as a gift on behalf of:

Name

 I will notify this person on my own

 Please send a card by postal mail to this person at:

Address

City/Prov/Postal Code

How would you like to sign the card?

Special Message for the Card:

You will receive a tax receipt for your gift within 1 month.

We thank you for your generosity. The Canadian Working Group on HIV and Rehabilitation (CWGHR) does not trade, rent or exchange the names of our valuable supporters.

Charitable Registration Number 85699 5535 RR0001