Regional Council 15 Bequest Fund Application -

Pastoral Charge/Mission Unit/Project*

Pastoral Charge/Mission Unit/Project Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Revenue Canada Registered Charity Number*

Contact Person*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Email*

Enter Email Confirm Email

Cheque Payable To:*

Treasurer Name*

Important - Please indicate person (Treasurer) to whom cheque is sent.

First Last

Address where cheque is to be sent*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Regional Council 15 Bequest Fund Application