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The Bearded Collie Club of Canada
Mortimer Memorial Program
Donation Form


Donor:
Name:

Dog Being Commemorated:
Registered Name:

Call Name:

Date of Birth:    Date of Death:

Owner:
Name:

Address:

City:    Prov./State:

Country:    Postal/Zip Code:

Email:

Amount of Donation to BCCC Rescue:  
(minimum amount suggested: $30.00)

Donor information (if different from above):
Address:

City:    Prov./State:

Country:    Postal/Zip Code:

Email:

Comments or questions:

Please print this page before submitting (2 copies would be best: one copy for your records and one copy to mail with your cheque).

 

Please mail a cheque (payable to the BCCC) for the amount of the donation along with a copy of this page to:

Ann Midgley,
320 Chapel Street,
Ottawa, ON     K1N 7Z3

Canada

If you have questions, please email Ann Midgley

 
 
 
 
 
 
 
 
   


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All rights reserved

Last revised: March 31, 2017