Burnaby Christmas Bureau

Sponsor a Senior Hamper
* required field

All your contact information will be kept strictly confidential.

Sponsor Name
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: 1 Person 1 Couple Cost: $80 $150 Request:

Notes: May we recognize you as a donor publicly? No, we would like to participate anonymously Yes, you may recognize our       participation publicly Would you be interested to share your experiences through the media? No, I am not interested Yes, contact me for more information Would you like a Community Award for your group? No, thank you Yes, please! 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 confidential 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