Sample Form for Fund Raising for NWT Charities via Political Contributions

Political Contribution Charitable Fundraising

Sample Site:(initial draft)

First Name	Last Name
*	*
Postal Address	Street Address
*	*
Electoral District (Constituency)	Community
	*
Day Phone	Postal Code
	*
Home Phone	Email Address
*	*

Choose A Candidate Your Contribution Is To Support*

Nunakput	Mackenzie Delta

Sahtu (acclaimed)	Inuvik Boot Lake (acclaimed)

Nahendeh	Inuvik Twin Lakes

Monfwi	Inuvik Twin Lakes

Deh Cho (acclaimed)	Range Lake

Tu Nedhe	Kam Lake

Great Slave	Yellowknife Centre

Weledeh	Yellowknife South

Thebacha	Hay River North

	Hay River South

Amount of Contribution	Method of Payment
*	*

Choose A Charity You Prefer to Support with Funding Surplus*
Social	Health

Education	Elderly

Sports	Religious

Youth	Brotherhoods