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In Memoriam Donation

Upon receiving this completed form and your
contribution, the Hospice will immediately send a
card to the family acknowledging your donation
made in memory of their loved one.

You will receive a tax receipt for your donation.

Your donation may be mailed to:

The Hospice at May Court
114 Cameron Avenue
Ottawa ON K1S 0X1

Enclosed is my contribution of $ ___________

Made in the memory of:

________________________________________

Please send a card acknowledging this gift to:

Name:______________________________________

Address:____________________________________

___________________________________________

Please sign card from:

Name(s)_____________________________________

Please send a tax receipt to:

Name:______________________________________

Address:____________________________________

___________________________________________