I would like to make a donation to the Ontario Society (Coalition) of Senior Citizens' Organizations (OCSCO).

Please make cheque payable to: OCSCO

I am enclosing a Cheque for $40____ $50____ $100____

Other Amount $__________

Please debit my Visa Card Number: _____________________________

Expiry Date: ______________

Card Holder Name: _____________________________________________

Your Contact Details:

Name: _______________________________________________________

Address: ______________________________________________________

_____________________________________________________________

_____________________________________________________________

Telephone: ____________________________________________________

Please mail donation to: OCSCO

660 Briar Hill Avenue

Suite 207

Toronto, Ontario

M6B 4B7

Or fax form to: (416) 785-7361

Thank you for your continued support of OCSCO and its programs.

OCSCO will provide you with an official receipt for Income Tax Purposes

Charitable #88502 6351 RR0001