Chain of Action™ Donation Form

If you are making a donation with a cheque, please print out and complete this form and mail it with a cheque payable to Chain of Action to:

Chain of Action

3310 South Service Road East

Suite 300, Burlington Ontario

L7N 3M6

Name: __________________________________________________________

Email: __________________________________________________________

Address: ________________________________________________________

City: ____________________________________________________________

State: _______________________________________

Zip: __________________

Donation Amount:

o $25 o $50 o $100 o $150 o $200 o Other ________

I prefer to make an anonymous donation

If you would like to have your donation go to support a particular project, please check one of the following boxes:

Chain of Action Assistance Fund: a fund that provides assistance to people in need.

Towards getting more Chain of Action key chains out in the community. We will do this on

your behalf and make note of your donation on the website.

Thank you for supporting Chain of Action™