Gilda’s Givers: A Monthly Giving Club So that no one faces cancer alone.TM YES, I would like to become a Gilda’s Giver and make a monthly donation to Gilda’s Club. $_________ a month, so that no one faces cancer alone. $11 every month, to fund one person’s participation in a weekly support group. $18.50 every month, to cover the cost of one child participating in the full program for children, youth and families. $47.55 every month, to fund one person’s full participation in our emotional and social support program. Method of Gift Payment: Pre-authorized debit from my account (please include a VOID cheque with this form) VISA  MasterCard  AMEX: Card Number _________________________________ Expiry Date ___/___ Please process my donation on the  1st or the  15th of every month. Signature:_____________________________________________________ Date: ______________   Email Name(s) Organization (if applicable) Address City, Prov, Postal Code Telephone Gilda’s Club Simcoe Muskoka is a registered charity (Registration# 87366 4205 RR0001) and we respect the privacy of our donors. Information collected will be used to issue receipts and to inform you about Gilda’s Club activities, news and events. Please send your completed form by mail, fax or email to: Gilda’s Club Simcoe Muskoka, 10 Quarry Ridge Rd., Barrie, ON L4M 7G1 Tel: 705-726-5199 Fax: 705-726-7101 Email: admin@gildasclubsimcoemuskoka.org You may cancel your monthly donation at any time, with a notice of 15 business days. Simply phone us at the number above. For more information about cancelling pre-authorized donation please contact your financial institution or visit www.cdnpay.ca.