NBRS Printable Donation Form

Yes, I want to help Make Media Accessible.

Step 1: Donation Amount

Yes, I'd like to support NBRS. Here is my donation for:

$25 / $50 / $100 / $200 / Other: $_______

Step 2: Donation Category

Please select a category for your donation.

__ NBRS Donation

__ NBRS "In Memory" Donation (To commemorate the life of:___________________________)

__ Friends of VoicePrint

__ Special Fundraiser

__ Monthly Donation (see below for details)

Step 3: Payment

Cheque, payable in the amount of $______________ to The National Broadcast Reading Service Inc., is enclosed.

OR

Charge the amount of $______________ to my:

Visa | MasterCard (circle one)

Card No.: ____________________________________________

Expiry Date: ___________________

Signature: ___________________________________________

Today's Date: __________________

Payment For Monthly Donation

Yes, I will become a monthly donor. (You can change or cancel your monthly contribution at any time by writing to us or calling us toll-free at 1-800-567-6755.)

Once a month I will give: $5 / $10 / $20 / Other $______ per month

I have enclosed a blank cheque marked "VOID." By signing below, I authorize The National Broadcast Reading Service Inc. to deduct the amount specified from the account number on the cheque, on the first business day of each month.

OR

I authorize The National Broadcast Reading Service Inc. to charge the amount specified above to my credit card each month.

Visa | MasterCard (circle one)

Card No.: ____________________________________________

Expiry Date: ___________________

Signature: ___________________________________________

Today's Date: __________________

We will issue a tax receipt for donations of $10 or more.
Charitable registration no: 128778552RR0001

Early in the new year we will send you an official receipt for your total annual contribution.

Mail to:

The National Broadcast Reading Service Inc.
303-1090 Don Mills Rd.,
Toronto, ON M3C 3R6
Canada