Donation Form

To make your donation to Nova Hudson, please print and complete this form and mail it with your cheque (payable to NOVA Hudson) to the address below.

Name: __ Mrs __ Ms __ Miss __ Mr __ Dr ___________________________________

Address (for tax receipt): _______________________________________________________

City: ______________________ Province: ____________ Postal Code: ________________

Tel.: _______________________ Fax: _________________ Email:______________________

Donation amount enclosed: $_________

I would like to make this gift in honour of _________________________________________ or

I would like to make this gift in memory of ________________________________________

Address (for notification card): ___________________________________________________

City: ______________________ Province: ____________ Postal Code: ________________

Charitable Registration Number: 12577 7011 RR0001

Please send to: NOVA Hudson

98 Cameron Ave, Hudson, QC J0P 1H0

Telephone: (450) 458-5727 Fax: (450) 458-5456

Email: Admin@NovaHudson.com Web site: www.NovaHudson.com