THORNHILL HERITAGE FOUNDATION
PICK A PICKET - FUNDRAISING APPLICATION
"Pick A Picket Donation: $ 50 per picket for an individual; $ 250 per picket for a business
NAME: _______________________________________________________________
E-MAIL ADDRESS: _____________________________________________________
TELEPHONE NUMBER: _________ - ________ - ________
MAILING ADDRESS: ____________________________________________________
_____________________________________________________________________________________________
APPLICANT'S SIGNATURE: _______________________________________________
DATE: ___________________________________
Name to appear on the Plaque:
Maximum number of characters / letters is 32 ... including spaces
Please print clearly using upper case letters
_________________________________________________________________________________________________
"Pick A Picket" donations may be sent
by e-transfer to thf1@rogers.com or
by cheque to the Thornhill Heritage Foundation, 7780 Yonge St. Thornhill, Ontario L4J 1W3