Have you sponsored a family before?:
<input name=”Sponsor_Before_Yes” type=”radio” value=”Sponsored before – Yes”>
Yes
<input name=”Sponsor_Before_No” type=”radio” value=”Sponsored before – No”>
No |
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Sponsor Name:
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Contact #1:
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<input id=”Contact 1″ maxlength=”35″ name=”Contact 1″ size=”32″ type=”text”> |
Contact #2:
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<input id=”Contact 2″ maxlength=”35″ name=”Contact 2″ size=”32″ type=”text”> |
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Address:
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<input id=”Address” maxlength=”35″ name=”Address” size=”32″ type=”text”> |
City:
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<input id=”City” maxlength=”35″ name=”City” size=”32″ type=”text”> |
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Province:
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<input id=”Province” maxlength=”35″ name=”Province” size=”32″ type=”text”> |
Postal Code:
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<input id=”Postal Code” maxlength=”35″ name=”Postal Code” size=”32″ type=”text”> |
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Phone:
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<input id=”Phone” maxlength=”35″ name=”Phone” size=”32″ type=”text”> |
Fax:
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<input id=”Fax” maxlength=”35″ name=”Fax” size=”32″ type=”text”> |
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Email:
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<input id=”Email” maxlength=”35″ name=”Email” size=”32″ type=”text”> |
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We/I would like to help by sponsoring
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We/I wish to help a family(ies) of
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Preferred Langley area of delivery:
<input id=”City of Langley” name=”City of Langley” type=”checkbox” value=”Langley City”>
City of Langley
<input id=”Township of Langley” name=”Township of Langley” type=”checkbox” value=”Township of Langley”>
Township of Langley |
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(Please note: The Langley Christmas Bureau makes every effort to accommodate specific requests, but general needs will be identified first).
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Notes:
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<textarea id=”Notes” name=”Notes”> |
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Oath of Confidentiality
WHEREAS, I understand as a condition of my involvement as a SPONSOR that I am expected to maintain this confidentiality during and after my invlovlement.
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 Langley 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 it.
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Name:
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<input id=”Signature” maxlength=”35″ name=”Signature” size=”32″ type=”text”> |
Date:
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<input id=”Date” maxlength=”35″ name=”Date” size=”32″ type=”text”> |
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