Help Fight Poverty
In support of The Salvation Army Christmas Appeal.
Please print clearly. Photocopy form as required.
Collect a minimum pledge of $50 and the runner will receive a FREE T-shirt
or T-shirts can be purchased for $15 each.*
*Subject to availability
2017
Pledge Form
TO ALL DONORS: All donors should be aware that The Salvation Army cannot monitor the door-to-door solicitation of pledges in connection with the Santa Shuffle. If a participant fails
to submit pledges, The Salvation Army is unable to issue a donation receipt. The Salvation Army encourages on-line donations for which donation receipts are immediately issued. On-line
donations can be made at www.SalvationArmy.ca.
TEAM
INDIVIDUAL
Team Name (if entered as a team)
Team Captain’s First Name
Team Captain’s Last Name
Team Captain’s Telephone
Team Captain’s Email Address
Participant’s First Name
Participant’s Last Name
Address
City
Postal Code
Telephone
Province
Email Address
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
First Name
Last Name
Address
City
Province
Email Address
Cash ❍
Cheque ❍
Postal Code
Telephone
Thank you for your support. Your participation will help many families and individuals over
this winter season.
❍ Tax receipt
❍ Opt out ‡
$
❍ Tax receipt
❍ Opt out ‡
$
❍ Tax receipt
❍ Opt out ‡
$
❍ Tax receipt
❍ Opt out ‡
$
❍ Tax receipt
❍ Opt out ‡
$
❍ Tax receipt
❍ Opt out ‡
$
Total pledges collected:
*DO NOT include online donations ________________
‡Opt out Clause: The personal information that you provide us is used for the purpose of maintaining contact with you. Make cheques payable to: The Salvation Army
The Salvation Army does not sell, trade or otherwise share your information. If at any time you wish your information
Charitable tax receipt for donations of $10 or more.
to be removed from our list, simply contact us by telephone at 1-800-SAL-ARMY (1-800-725-2769) or by
The Salvation Army charitable #: 107951618 RR0001
email at [email protected].