The Friends of the Loyalist Collection at Brock University.
My Name:___________________________________________________________
Street and Number:___________________________________Apt No._________
City:_________________________________Province /State________________
Country:_______________________Postal/Zip Code:______________________
Amount of the Donation:$__________________CDN or US (Please circle one)
Type of Gift (Circle one) Birthday, Christmas,
Name of Person for memoriam:_________________________________________
Name to Receive Card:________________________________________________
Street and Number:___________________________________Apt No._________
City:________________________________Province /State________________
Country:______________________Postal/Zip Code:_______________________
Enclose your cheque or money order and Mail to:
The Friends of the Loyalist Collection at Brock University,
P.O. Box 23041, RPO Seaway Mall,
800 Niagara St.,
Welland, ON. Canada.
L3C 7E7