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Donor Information
* = required
Full Name *
Affiliation *
Class Year     (4 digits, if applicable)
Address Line 1 *
Address Line 2  
City *
Province/State *
Postal/Zip Code *
Daytime Telephone *
Email *
Annual Giving Clubs
Friendís ClubUp to $999
Headís Club$1,000 Ė $2,499
Governorís Club$2,500 Ė $4,999
Pactum Serva Club$5,000 Ė $9,999
Visionary Club$10,000 - $24,999
Founder's Club$25,000 and greater
Donors at the Headís Club and above will be invited to the annual Pactum Serva Donor Recognition Dinner.

Charitable Business No. 10729-9513RR0001

Directed Donation
* I would like this gift to be directed to:
Annual Campaign Priority Fund (this flexibility would be of most benefit to Elmwood)
Annual Campaign Scholarships and Bursaries
Annual Campaign Athletics
Annual Campaign Science and Technology
Annual Campaign Arts and Music
Annual Campaign Heritage and Restoration
Other (Please Specify)
Donation Amount and Payment Information
Yes, I would like to donate * to the 2013-2014 Annual Giving Campaign
Please debit my credit card *
Please indicate your choice below  
Monthly         with payment/installments of  
One-time Gift  
Perpetual Payments?   I wish to pay the installment amount on a recurring basis until further notice
Your credit card details will be kept securely on file only if needed for installment payments
Payment/Pledge Type *
Matching Gifts?
Please indicate whether your employer or your spouse's employer will match your gift.
  Yours | Spouse | Organization Name(s)
Yes, matching form will be sent later
No, matching not available  
In Honour / Memory of
I would like this gift to be in Honour / Memory of:
      In Honour   In Memory
  Please send an acknowledgement of my gift to:
Special Instructions
Any special instructions we should know?


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