Donation Form

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PERSONAL INFORMATION 
 
 
  
 
   
    
 
 
 
   
  
For one of the following:
 
Opportunity Fund (Directed to island acquisition projects)
 
Lasqueti Island Acquisition Fund (Geographically Restricted Fund) 
Gambier Island Acquisition Fund (Geographically Restricted Fund) 
 
Thetis Island Acquisition Fund (Geographically Restricted Fund) 
Covenant Management and Defence Fund  
Donation amounts are confidential and will not be publicly released. 
I am willing to let my name be known as a supporter: 
No 
 
PAYMENT METHOD 
Please make cheques payable to: Islands Trust 
Conservancy
Print and mail this form to: 
Islands Trust Conservancy 
Suite 200 - 1627 Fort Street 
Victoria, BC  V8R 1H8 
Freedom of Information 
Personal information contained on this donation form is collected under 
the authority of the Islands Trust Act Section 42 (2) (a), and is subject to the 
Freedom of Information and Protection of Privacy Act. The personal 
information will be used for purposes associated with the Islands Trust 
Conservancy’s (ITC) Strategic Charitable Giving Program. Enquiries can be 
directed to the ITC Manager at (250) 405-5191. 
 
 
  
Credit Card Number: 
Expiry Date: 
Month 
Year 
Credit Card Security Code (CSC)     
Name on Card: 
(As shown on card) 
Total: 
Thank you very much for your support! 
 
 
 
 
 
Please indicate whether your gift is in memory or in honour or memory of someone: 
Yes 
No 
Yes 
My gift is in memory My gift is in honour Person’s Name: 
 
 
  
 
DONATION INFORMATION
we will direct 100% of your donation to our Opportunity Fund which supports local conservancies.
     All donations to the Islands Trust Conservancy are tax-deductible. Unless otherwise requested, 
Here is my donation of: 
$50 $75 $100 
$1000 Other Amount:
Property Management Fund 
Telephone 
Cell 
Email
City 
Province/Region
Name 
Postal/Zip Code
 
 
    
 
  
Address
 
 
    
 
  
Cheque 
Visa                 MasterCard
   
    
 
  
    
    
 
  
    
    
 
  
   
    
 
  
Donation Form
Website: islandstrust.bc.ca/conservancy/ | Email:itcmail@islandstrust.bc.ca
Toll Free via Service BC in Vancouver 604.660.2421 Elsewhere in BC 1.800.663.7867 
Fax: 250.405.5155
Telephone: 250.405.5186
Suite 200 - 1627 Fort Street, Victoria, BC V8R 1H8

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