Birth Control Venereal Disease Information Centre Donation Form
Amount:		$20 $50 $100 $200 other $_________
Name:		____________________________________________________________
Address:		____________________________________________________________
		____________________________________________________________
City:		_________________________
Postal code:		_________________________
Phone:		_________________________
E-mail:		_________________________
		Make cheques payable to: Birth Control and Venereal Disease Information Centre Print and mail completed form to: BCVD 2828 Bathurst Street, Suite 501 Toronto, Ontario M6B 3A7 We are a registered charity. Would you like us to mail you a receipt for income tax purposes? Yes No