Donor's Name:__________________________________________________________

Donor's Address:_______________________________________________________

____________________________________________________________________

Donor's Phone Number:__________________________________________________

Donation Made in Honour of:____________________________________________

Or

Donation Made in Memory of:____________________________________________

Total Enclosed:________________________________________________________

Is A Tax Receipt Required? (Please Circle Yes or No). YES / NO

White bulbs are lit in memory or a loved one.
Coloured bulbs are lit in honour of a living individual.
Offical Income Tax Receipts Available for amounts of $10.00 and over. Please make cheques payable to Tree of Life or Save A Life Fund. Forms can be mailed or dropped off to Norwich Save A Life a Fund, c/o White Coad LLP 6 Stover Street North Norwich Ontario N0J 1P0 or to Norwich Save A Life a Fund, c/o Andrews Service Station 99 Main Street West Norwich Ontario N0J 1P0

The Norwich Gazette will publish the names of individuals who have had lights dedicated to them.

Return to the Main Save A Life Fund Page