Name __________________________________________________
Address ________________________________________________
City ____________ Postal Code ___________ Phone ____________
I prefer to give ________, and I have enclosed a cheque, or
I authorize TVCC to charge my credit card $ ________
Visa 
Mastercard .
Card # ________________________
Expiry Date ____________________
Signature ____________________________
Print out the above donation form and mail or fax it to:
Thames Valley Children's Centre,
779 Base Line Road E.
London, ON
N6C 5Y6.
Phone: (519) 685-8675
Fax: (519) 685-8699
