"Fifty-Plus and Fabulous"
2005 Charity Calendar*
Order Form

(NOTE: THIS IS NOT AN E-MAIL FORM BECAUSE WE REQUIRE YOUR SIGNATURE AND THE DATE.
PLEASE PRINT THE FORM AND MAIL IT AS INDICATED BELOW.)

Name:____________________________________________________________________

Street Address:_____________________________________________________________

City:_____________________________ Province/State: ____________________________

Country:__________________________ Postal/Zip Code: __________________________

Phone: (      ) ________________ E-Mail: ________________________________________

Signature: __________________________________________ Date: __________________


I wish to order _____ calendar(s) at the price of $20.00 each.

I have included a cheque or money order (Payable to: "HopeSpring Cancer Support centre").
Please send my order by mail.
(Add $7.50 for shipping and handling plus $1 for each additional calendar.)

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Preview of one of the Calendar Photos
 Mail to:

Pat Haney
11-25 Grand River Blvd,
Kitchener, Ont.
N2A 2T2

For information, contact:
519-748-2489
e-mail: pathaney@execulink.com

* Proceeds to HopeSpring Cancer Support Centre, 43 Allen Street West, Waterloo, Ontario