DONATION
FORM
Riders name (optional): _______________________________________________
_____ .01 X
2100 km = $21.00
_____ .10 X
2100 km = $210.00
_____ $1.00 x 2100 km = $2,100.00
_____ $ 10.00 x 2100 km =
$21,000.00
_____ Other
Amount _________
If you would like to donate and
you live in Canada – you can send cheques to:
Stansberry Children’s Home and Daycare
– Canada
Box 182
Duchess, AB T0J 0Z0
If you live in the U.S. –
you can send cheques to:
Stansberry Children’s Home
12002 Arnold Rd.
Orrville, OH 44667
If you want to donate online,
go to: http://stansberrybolivia.com or click
on the photo above.
