The Muskoka 200 – South Muskoka Hospital Foundation

Giving back, it’s what we do.

The Muskoka 200

Join us and become a part of something unique and special that will make a difference in the lives of those in our community, both today and in the future.

PLEDGE FORM

My Lifetime Annual Pledge: $5,000 to South Muskoka Hospital Foundation

Name

Company/Organization (if applicable)

Phone

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Mailing Address

Mailing Address Line 2

City

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I would like my pledge to start on the below date. A reminder one month in advance of your pledge payment due date will be sent.

I prefer to complete my $5,000 pledge every year in:

I would like to fulfill my pledge via: Cheques to each organizationDirect Debit (enter bank details below)Credit Card (enter card details below)Gift of Securities (Foundation Office will contact)

Direct Debit:Bank Name

Transit Number:

Account Number:

Institution Number:

Credit Card: Indicate Card Type :Visa/Mastercard/AMEX

Card Number:

Expiry

CVC Number:

I agree this pledge will be in perpetuity, unless I contact SMHF to request otherwise.

Thank You to Our Generous Donors

Your commitment to improving healthcare in South Muskoka is truly admirable.

Giving back, it’s what we do.

Thank You to Our Generous Donors

our community is our foundation.

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