Page 1
Page 2
Page 3
Page 4
MMakeaPersonalDonationx0Titlex0_______x0Firstx0Namex0________________________x0Lastx0Namex0________________________x0x0x0e.g.x0Mrx0Mrsx0DrMMakeDonationonbehalfofanOrganizationx0x0x0Namex0ofx0Organizationx0_____________________________________________Addressx0_____________________________________________________________x0CityTownx0________________________________ProvinceStatex0__________________________x0PostalZipx0Codex0______________________x0Country________________________Phonex0x0_______x0x0____________x0Extx0______x0E-mailx0Addressx0__________________________________________________________MIx0givex0permissionx0forx0thex0Davidx0Fosterx0Foundationx0tox0contactx0mex0viax0e-mailx0withx0informationx0aboutx0howx0Ix0canx0supportx0x0childrenx0receivingx0lifex0savingx0organx0transplants.Additionalx0Commentsx0_____________________________________________________________________________________________Amountx0_______________x0Currencyx0______________x0x0MOnex0Timex0Creditx0Cardx0Paymentx0x0x0MRecurringx0Monthlyx0PaymentCreditx0Cardx0Typex0x0x0MVISAx0x0x0MMCx0x0x0MAMEXx0Creditx0Cardx0x0________________________________________________________Cardx0Securityx0x0__________x0Cardx0Holderx19sx0Namex0_____________________________________x0Expiryx0Datex0MMYYx0________Ix0wouldx0likex0tox0makex0ax0donationx0inx0memoryhonourx0ofx0_______________________________________________________________MPleasex0notifyx0thex0nextx0ofx0kinx0thatx0ax0donationx0hasx0beenx0made.x0x0x0MIx0wouldx0likex0tox0keepx0myx0giftx0private.DavidFosterFoundationDonationFormTankyouforsupportingchildrenandtheirfamiliesreceivinglife-savingorgantransplants.DonationscanbemailedtoDavidFosterFoundation212HenryStreetVictoriaBCV9A3H9CANADACanadianx0Charitablex0Businessx0No.x010700x04210x0RR0001.x0USx0Federalx0IDx0No.x081-0581479.x0Taxx0receiptsx0willx0bex0issuedx0uponx0receiptx0ofx0donation.x0Donationsx0canx0alsox0bex0madex0onlinex0atx0www.davidfosterfoundation.comCamaroGiveawayKellyNyberga24yearoldnativeoSiouxFallsSouthDakotaisthewinnerothe4monthlongDavidFosterFoundationOfcialPaceCargiveawaycontestthatstartedinLongBeachCaliorniaandendedattheIndianapolis500.TeFoundationputtogetheratruckandtrailerroadshowtotravelthecountrypromotingthecontestaswellaseducatingandencouragingAmericanstomakethedecisiontobecomeregisteredorgandonorsintheirownStateandormakeadonationeitherbytextmessageoronline.x1cIcanx19tbelieveIwonIwillcertainlyenjoythisCamaroabsolutelycannotwaittodriveitTankssomuchorthisantasticopportunityIeelsoluckyx1dsaidthediminutivebrunettewhonowworksandlivesinLosAngeles.Te2011CamaroConvertibleisthe22ndChevroletchosentopacetheIndianapolis500andtheseventhCamaro.Addingtotherichheritageistheactthat2011markedthe100thanniversaryothex4rstIndianapolis500aswellasthecentennialyearoChevrolet.x1cOurexperienceduringthis4monthcampaignintheUnitedStateswasamazing.Wewereabletoprovideeducationabouttheimportanceoorgandonorregistrationandweheardsuchgreatstoriesrompeoplewhoselivesweretouchedbyorgandonationandtransplant.Iwex19vesavedevenoneliethroughthisendeavourweeellikewex19vemadeadix3erencex1dsaidDavidFosterFoundationCEOMikeRavenhill.Tisspecial-editionChevroletCamaroConvertibleservedastheofcialpacecarothe2011Indianapolis500wasoneoonly50ofcialpacecars.EarlierthisyearoneothoseCamaroswasgix2edbyChevroletandtheIndianapolisMotorSpeedwaytotheFoundationandauctionedox3attheBarrettJacksonAuctionwiththeullproceedso225000goingtotheDavidFosterFoundation.DFFCEOMikeRavenhillhandsoverthekeystocarwinnerKellyNybergofSiouxFallsSouthDakota.www.davidfosterfoundation.comFall20114