Donation by Mail or Fax
Help make a difference in the lives of people worldwide with your tax-deductible gift to CNANW.
Print this form and send with a cheque or credit card information to:
c/o Project Ploughshares
140 Westmount Road North,
Waterloo, Ontario, Canada.  N2L 3G6

* Denotes Required Information

Yes, I would like to become a CNANW Donor. Please add me to the Donor's mailing list of the Canadian Network to Abolish Nuclear Weapons.

My pledge:
Monthly Commitment A One-Time Gift

Please charge my credit card in the amount of:
$25  $50  $100 $250 $500 $1000 other $______

Name(s)* __________________________
Address* __________________________
City* __________________________
State/Province* _____________  Zip/Postal Code______________
Country* __________________________
Phone (______)___________________
Fax (______)___________________
E-mail ___________________________
Credit Card Type* Visa Mastercard
Card Number* __________________
Expiration Date* ______/____________
I require tax receipt. (My contribution will be directed to the Canadian Network to Abolish Nuclear Weapons.)
Send any information package by regular mail.
I am enclosing a cheque. Please make cheque out to Project Ploughshares, and indicate that the donation is a contribution to CNANW.

Please contact us if you would like further information.
Thank you for your support.