Help us Light the Lake! Money raised by Envision Financial Light the Lake goes directly to student aid at Douglas College and critical medical equipment at Eagle Ridge Hospital.

To make a donation, please print this form and mail or fax to Eagle Ridge Hospital Foundation. We would also be happy to accept your donation by phone or email. Please include relevant contact information. Tax receipts will be issued for all donations of $20 or more. Thank you for your donation.

Light the Lake - Eagle Ridge Hospital Foundation
475 Guildford Way
Port Moody, BC V3H 3W9
Tel: 604-469-3128 Fax: 604-469-3245

Email: mya.fortin@fraserhealth.ca

Yes! I would like to help Light the Lake with a donation of $                 .

Please select one:

   I have enclosed my cheque payable to Eagle Ridge Hospital Foundation.

   I have included my credit card information.

   Contact me by phone for my credit card information.

   Contact me by email for my credit card information.

Name(s) of Donor: ______________________

Address: ___________________________

City: __________________ Postal Code: __________________

Home Phone: _________________

Work Phone: _________________

Name of Cardholder: ______________________________

Card No: __________________________

Expiry Date: _________

   I wish to remain anonymous.