Louis Riel Institute Donation Form

Please complete and drop off or mail to:

If you require additional information, please phone (204) 984-9480 or fax (204) 984-9484.

Yes I would like to donate to the Louis Riel Institute Library
My Contribution Ammount:

$25
Order of the Sash

$50
Order of the Cart

$100
Order of the Buffalo

Other

Please make cheques payable to: Louis Riel Institute

Donation Information:

Your Name:
Street Address:
City:
Province:
Country:
Phone Number:
E-mail:

Please check this box if you do not wish to be recognised for your contribution:

Please check if appropriate:
In Memory Of
In Honor Of

Memory/Honor Information:

Name of Person:
Address: