****FLT Charitable Number: 80839 3359 RR0001 ****

Annual amounts over $ 25.00 eligible for Charitable Tax Receipt.

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m If by Cheque. Please make cheque payable to The Farmlands Trust.

My Contact Details:

Name:________________________________________________________________________________

Spouse Name:__________________________________________________________________________

Address:______________________________________________________________________________

City:__________________________________Province:__________________Postal Code:___________

Home Phone:______________________________________________________________________

E-mail:_______________________________________________________________________________
m Please check here if you do not wish to be kept informed of FLT events and activities by e-mail.

Thank-you!

Please return completed form with cheque to:
The Farmlands Trust, PO Box 9, Saanichton BC, V8M 2C3.
Or, for immediate service, please call us at: 1-250-483 1468.

for FLT use only - FLT Staff/ Volunteer ________________________________ Date:___________
Site/ Event/Appeal:_________________________________________________ Renewal?___________