Reward Redemption Form
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My shipping address is different
No
Yes
Shipping Address (If different from Home Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Redeem from the items below based on your donation total (found in the email that was sent):
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( X )
Matched Donation
$100 CAD
$
100
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Golf Savings Book
$250 CAD
$
250
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Radon Kit or Air Quality Monitor
$500 CAD
$
500
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
2 Tickets to Wonder Gala
$1,000 CAD
$
1,000
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
I would like to redeem:
Level 1 ($100): Matching Gift
Level 2 ($250): Golf Savings Book
Level 3 ($500): Air Monitor or Radon Test Kit
Level 4 ($1000): 2 Tickets to Wonder Gala
Would you like an Air Quality Monitor or Radon Test Kit?
Please Select
Air Monitor
Radon Test Kit
Would you like to gift the Air Quality Monitor or Radon Test Kit?
Please Select
Yes, please give it to someone in need
No, please send it to the address above
Submit
Should be Empty: