Manitoba Prostate Cancer Support Group Donations

CAN YOU HELP?

The Manitoba Prostate Cancer Support Group operates on your donations

We need your contributions

Have you used any of our services?

Newsletter - General Meetings - Hospital visits - One-on-one visits - Speakers

Name: q Mr. q Mr. & Mrs. q Mrs. q Ms q Miss

_____________________________________________

Address:______________________________________

___________________ Postal Code: ____________

Card to be signed from: _________________________

q This gift is IN MEMORY of:

____________________________________________

q This gift is IN HONOUR of:

____________________________________________

q Birthday q Confirmation q Get Well q Wedding

q Graduation q New Arrival q Anniversary q Bar/Bat Mitzvah

q Other:____________________________________

q In appreciation for:__________________________

Please notify the following person of this gift:

Name:______________________________________

Address:____________________________________

__________________ Postal Code: ___________

q $25 q $50 q $100 q $250 q $500 q $1000

Make cheque or money order payable to:

Manitoba Prostate Cancer Support Group (MPCSG)

# 705 - 776 Corydon Ave., Winnipeg R3M OY1

*a tax deductible receipt will be issued.