Québec Foundation for the Blind
(Fondation des aveugles du Québec)
Head Office
5112 Bellechasse
Montreal, (QC) H1T 2A4
Tel : 514.259.9470
Fax : 514.254.5079

In Memoriam

When a loved one passes away, many families request that donations be made to a specific cause or one of choice. A donation In Memoriam is a nice way for parents and friends to express sympathy wishes.

How to make a donation In Memoriam

By calling our offices at 514.259.9470. We accept Visa and MasterCard.

By mailing this form at the Québec Foundation for the Blind, 5112 Bellechasse, Montreal, (QC) H1T 2A4, or by faxing it at 514.254.5079 and mailing in your cheque.

IN MEMORY OF	NAME OF DONATOR
Name : Date of passing : City :	____________________________ ____________________________ ____________________________	Name : Address : City, postal code :	____________________________ ____________________________ ____________________________ ____________________________
			(A receipt will be emitted for donations over 20$)

IN MEMORY OF

NAME OF DONATOR

Name :

Date of passing :

City :

____________________________

Name :

Address :

City, postal code :

____________________________

(A receipt will be emitted for donations over 20$)

We will acknowledge your donation by sending a sympathy card to the family advising them, without revealing the amount, that a donation has been made to our Foundation in honour of their loved one.

Please send a card to:

<> Mr. or <> Mrs. :

Address :

Ville :

City, postal code :

_________________________________________

Your donation is precious to us. Thank you!