DONATION

TO DORSET
COMMUNITY HEALTH CARE HUB
PLEASE CHECK THE FUNDRAISER FOR WHICH YOU ARE DONATING:
1000 CANOES

500 MILES (Gord Hendersons 2-week solo hike of the Camino de Santiago!)

In Memoriam of:

Please Print
NAME:
ADDRESS:

PHONE #:
E-MAIL (to send taxable receipt):
DONATION AMOUNT:
DATE:
SIGNATURE:

IF YOU ARE TAKING PART IN 1000 CANOES, PLEASE TELL US WHERE YOU WILL LAUNCH:
(i.e. Dorset/Trading Bay, Kawagama/Mountain Trout House Marina, or your own spot)

Thank you for your contribution!