Donation Amount

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Yes, you may publish my name as a donor in CIDT programs/newsletters and on the CIDT website.

No, please do not publish my name in CIDT programs/newsletters and on the CIDT website.

Please make cheque payable to:
Canada Ice Dance Theatre

Please print & mail this form to:

CIDT - Donations
#201-750 Denman St.
Vancouver, B.C. Canada V6G 2L5