BC - North Vancouver Island - Ski for MS 2010 Participant : Jessica Otte (3245223 - 1167607) Please complete this form and send it to the address listed below. To ensure an accurate tax receipt, please be sure to PRINT NEATLY. For security reasons, please DO NOT send cash in the mail. If sending a cheque, please make it payable to: MS Society of Canada. PO Box 656 Campbell River, BC V9W 6J3 Fax Number : +1 (250) 286-0994

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Donation Amount	An official tax receipt will be issued for paid pledges of $20.00 or more. Tax receipts will be issued within five (5) months of the funds being submitted. For inquiries call: 1-800-268-7582. $25$50$100Other
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