Gifts of Kindness Donation Form

2. First Name*

3. Last Name*

5. Date:
   Date:

   Date:

7. Address1

9. Address2

11. City

12. State

13. Zip

15. Phone Number

16. Email

    Tax Receipts will be emailed directly to address provided

18. Donation Method:

    1. Visa
    2. Mastercard
    3. American Express
    4. Cash
    5. Cheque
    6. Debit

19. Total Donation amount ($):

21. Credit Card number:

22. Name on Card:

24. Expiry Date:

25. CVS:

    number on the back of the card

27. Would you like to receive a tax receipt?

29. Donations are recognized on the City website and at public events, May we recognize you by publishing your name and donation amount?:

    1. Yes
    2. No

31. Thank you!
    The personal information is being collected for donation tracking and is such deemed to be an activity of the City of Chestermere. The personal information is collected under the authority of Section 33(1) of the Freedom of Information and Protection of Privacy Act, and will only be used for the purposes identified. For questions or concerns contact the FOIP coordinator at City Hall, 105 Marina Road, Chestermere, AB T1X 1V7 or call (403) 207-7050.

    The personal information is being collected for donation tracking and is such deemed to be an activity of the City of Chestermere. The personal information is collected under the authority of Section 33(1) of the Freedom of Information and Protection of Privacy Act, and will only be used for the purposes identified. For questions or concerns contact the FOIP coordinator at City Hall, 105 Marina Road, Chestermere, AB T1X 1V7 or call (403) 207-7050.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field