2017 Angel Cookie Gram Order Form

About You

Salutation:

First Name: *

Last Name: *

Email: *

Department/Unit: *

Phone Number: *

Total No. of Cookies: *

x $5 each =

Total:

0.00

Special Instructions:

We will make all reasonable attempts to deliver your Cookie Grams! However, in the event that we cannot complete the delivery, we will contact you for an alternative drop-off location. If you have any questions, please contact Emily at emily.wachtman@vghfoundation.ca or 604-875-4676 ext. 63354.

I would like my cookies delivered directly to me

Yes!

Would you like to receive email updates from
VGH & UBC Hospital Foundation?

Yes please!

About Your Angel

	Salutation	Honouree First Name	Honouree Last Name
-	Salutation	Honouree First Name	Honouree Last Name

	Floor/Unit	Room Number
-	Floor/Unit	Room Number

	Building		Delivery Date		Do you wish to be anonymous?		Cookie Type
-

Special Message to Include with your Cookie Gram:

0/200 characters

Want to send more Cookie Grams? There are places to include this information later in the form!

Payment Information

First Name: *

Last Name: *

Mailing Address: *

City: *

Province: *

Postal Code: *

Yes!

I want to make an additional donation to the 2017 Angel Campaign supporting the Most Urgent Needs Fund

Donation Amount:

Cookie Gram Total:

0.00

Clicking "calculate" will automatically add

the donation to your Cookie Gram total.

Your credit card will be charged for the purchase

and donation amount separately.

You will receive a tax receipt for your donation amount only.

Credit Card Number: *

Expiry Date: *

Credit Card Type: *

*

clear

Date Submitted: * +

The receipting and management of gifts are subject to the Canada Revenue Agency and the Foundation Board approved policies. VGH & UBC Hospital Foundation does not trade, rent or exchange the names of our valuable donors. Charitable Registration number 13217 3063 RR 0001

My Other Angels

Please enter details about your other Angel Honourees here. Add another Angel Honouree by clicking "Add Another Angel" at the bottom. By repeating this, you can add up to a maximum of 5 Angel Honourees on this form. If you would like to order more Cookie Grams, please submit an additional form or call Emily at 604-875-4676 ext. 63354.

	Salutation	Honouree First Name	Honouree Last Name
-	Salutation	Honouree First Name	Honouree Last Name

	Floor/Unit	Room Number
-	Floor/Unit	Room Number

	Building		Delivery Date		Do you wish to remain anonymous?		Cookie Type
-

Special Message to Include with your Cookie Gram:

0/200 characters

Add Another Angel?

Yes

	Salutation	Honouree First Name	Honouree Last Name
-	Salutation	Honouree First Name	Honouree Last Name

	Floor/Unit	Room Number
-	Floor/Unit	Room Number

	Building		Delivery Date		Do you wish to remain anonymous?		Cookie Type
-

Special Message to Include with your Cookie Gram:

0/200 characters

Add Another Angel?

Yes

	Salutation	Honouree First Name	Honouree Last Name
-	Salutation	Honouree First Name	Honouree Last Name

	Floor/Unit	Room Number
-	Floor/Unit	Room Number

	Building		Delivery Date		Do you wish to remain anonymous?		Cookie Type
-

Special Message to Include with your Cookie Gram:

0/200 characters

Add Another Angel?

Yes

	Salutation	Honouree First Name	Honouree Last Name
-	Salutation	Honouree First Name	Honouree Last Name

	Floor/Unit	Room Number
-	Floor/Unit	Room Number

	Building		Delivery Date		Do you wish to remain anonymous?		Cookie Type
-

Special Message to Include with your Cookie Gram:

0/200 characters

For Office Use Only

Submitted on: +

Printed by Gift Processing?

Yes

No