Burnaby Christmas Bureau

Provide a Subsidy
* required field

All your contact information will be kept strictly confidential.

Sponsor Name*
Contact Information
Contact Name*
Phone No.*
Fax No.
Address*
City*
Postal Code*
Email*	** Please include your e-mail address - we will not share it with anyone or send you spam. We prefer to communicate via e-mail to save time & money.
Alt. Contact.
Phone No.
Family Request
Please indicate the number of families you would like to sponsor under "request" next to the family size you would like to sponsor.  Family Size:  2 people  3 people  3-4 people   Max Cost:  $200-$250  $300-$350 $350-$450  Request:   Family Size:  4-5 people  5-7 people  7 or more   Max Cost:  $200-$250  $300-$350 $700  Request:
Notes: Oath of Confidentiality: WHEREAS, it has been explained to me that any information about clients secured by me or available to me, in the pursuit of my duties with the Burnaby Christmas Bureau is of a coincidental nature, and I, the undersigned, hereby undertake to respect that confidentiality and to take all reasonable precautions to safeguard during & after my involvement. Name: Date: