Thank you all for your support and congratulations to Danielle Smith.

Mark Dyrholm - Reforming Alberta

Candidate for Leader of the Alberta Wildrose Alliance Party

PERSONAL DONATION FORM TO COVER MARK DYRHOLM CAMPAIGN COSTS
Dr. Mr. Mrs. Ms.   Please Print Name
Home Address City Province
Postal Code
Phone # Cell Phone #
Email
Introduction was by: Fax Email Web Site Newspaper TV Telemarketer Door-to-door
Amount of personal Donation
Method of Payment Visa MasterCard Cheque and Money Order. (Please make all personal cheques or money orders payable to Mark Dyrholm)
Credit Card # Expiry Date:


CORPORATE DONATION
Dr. Mr. Mrs. Ms.   Please Print Name
Home Address City Province
Postal Code
Phone # Cell Phone #
Email
Introduction was by: Fax Email Web Site Newspaper TV Telemarketer Door-to-door
I was referred to the Mark Dyrholm Campaign by {name of campaign worker)
Amount of Corporate Donation
Method of Payment Visa MasterCard Cheque and Money Order. (Please make all corporate cheques or money orders payable to Exigency Consulting Ltd)
Credit Card # Expiry Date:




Please Note:
• Any amount donated will be appreciated, no amount is too small.
• ALL Blanks in each applicable section must be filled in.
• All Corporate cheques must be paid to Exigency Consulting Ltd and mailed with the above PDF
• All personal cheques must be paid to Mark Dyrholm

If you have any comments or questions they may be forwarded to membership@markdyrholm.ca.

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You can help Mark by making a donation, as campaign costs are still needing to be covered. Also you can still join the party if you are not already a member.

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