Pemberton Chapel and Pemberton Chapel Garden Donation FormRoyal Jubilee Nursing Alumnae Association One-Time Donation of:  $ _______________ Pledge of:  $_______________  for  2 months  ___    4 months  ___   6 months  ___ Cheques and Money Orders: Please make payable to:  "The Pemberton Chapel Fund" or "Pemberton Chapel Garden Fund".. Credit Card: VISA  ___   MasterCard  ___ Credit Card Number:  __________________________ Expiry Date:  month [        ]  year [        ] Signature:  __________________________________ Name:  (please print)  __________________________________ Address:  (please print) Apt. #  ______ Street __________________________________ City ________________________ Postal Code  ____________ Telephone:  home  __________________   business  __________________ Special instructions - i.e.  in memory of, acknowledgement to whom, etc. (Use the back of this form if you require more space) ___________________________________________________________________________ Please print this form, complete it and send it to us at: The Pemberton Chapel Fund c/o The Greater Victoria Hospitals Foundation #304 - 633 Courtney Street Victoria, BC Canada V8W 1B9 GVHF Charitable Number: #10793  5637  RR0001 Thank you for your support! The Royal Jubilee Nursing Alumnae Association <<  return to Home Page