EDMONTON SPACE & SCIENCE FOUNDATION - BE A STAR REQUEST FORM (Please PRINT using proper punctuation and capitalization for name and message.) DONOR INFORMATION DATE RECEIVED: DONOR NAME: ON BEHALF OF: DR./MR./MRS./MS/MISS FIRST LAST (IF DIFFERENT THAN DONOR NAME) ADDRESS: CITY: PROVINCE: TELEPHONE: (RES.) PREFERRED CONTACT: NAME: P/C: (BUS.) (FAX.) (RES.) (BUS.) E-MAIL: DONATION LEVEL: *YOU MAY SELECT THE CONSTELLATION YOU WISH YOUR STAR TO BE IN AT THE $250+ LEVEL $50 $100 $250 $350 $500 $1,000 *CONSTELLATION YOU WISH YES, PLEASE MAKE MY STAR EXCLUSIVE AT 5X THE DONATION AMOUNT STAR DONATION AMOUNT $ TAX RECEIPT SHOULD BE ISSUED TO: DELIVERY INFORMATION DELIVER TO: NAME: (IF DIFFERENT FROM ABOVE) ADDRESS: CITY: PROVINCE: POSTAGE/HANDLING: P/C: LETTER ONLY $5.00 WITHIN CANADA TEL: $5.75 TO U.S. *COURIER/EXPRESS POST: SPECIAL HANDLING CHARGES APPLY AS PER CURRENT RATES SEND VIA: MAIL PICK-UP *COURIER # OF EXTRA PACKAGES REQUESTED: POST. COST X $5.00* EACH = CASH $ *EXPRESS POST * $20.00 IF PURCHASED SEPARATE FROM ORIGINAL ORDER METHOD OF PAYMENT: $8.50 INTERNATIONAL EXTRA PKGS. $ TOTAL AMOUNT: $ CHEQUE/MONEY ORDER (PAYABLE: Edmonton Space & Science Foundation) VISA/MASTERCARD NO.: DEBIT CARD EXPIRY DATE: SIGNATURE: DEDICATION INFORMATION: DEDICATION TYPE: IN MEMORIAM BIRTHDAY ANNIVERSARY VALENTINE’S DAY OTHER DEDICATION DETAILS: RECIPIENT’S NAME DONOR’S NAME (APPEARS ON BE A STAR TERMINAL ONLY) *MESSAGE: DEDICATION DATE: *(MAXIMUM OF 100 CHARACTERS INCL. DONOR NAME, RECIPIENT’S NAME, MESSAGE & SPACES) OFFICE USE ONLY: STAR NUMBER: CONSTELLATION: PROCESSED BY: DATE: DATE ENTERED: MAILED CONFIRMATION #: PICKED UP COURIERED RECEIPTABLE AMOUNT: $ TELUS World of Science™ - Edmonton 11211 142 Street, Edmonton, AB T5M 4A1 Tel: 780-451-3344 Fax: 780-455-5882 E-mail: [email protected] Be a Star is a fundraising endeavour of the Edmonton Space & Science Foundation, to support the programs of TELUS World of Science™ - Edmonton, and is not an official astronomical designation. Be a Star Special Messages Love Messages May this star always remind you of the love we share. To the star in my life. You light up my life You are my shining star. This is the closest I can come to giving you a shooting star. I can’t give you the Universe, so this is the next best thing. The star in my life – You make my Valentine’s Bright. My love for you shines as bright as this star. Together in the night sky tomorrow. May our (your) love last forever, like this star. Graduation Congratulations on your Graduation. Your future is as bright as this star. You will always be the brightest star in my heavens. The sky is the limit. Shine as bright as you can! In Memory Her (His) memory will shine in our hearts forever. His (Her) spirit will shine on forever. Look up and you will see our beloved ________ for eternity. You were always my guiding light – Now you will shine forever. Special Occasions Happy Birthday Merry Christmas Happy Valentine’s Day Happy Anniversary Happy Mother’s/Father’s Day General To us you will always be a star. A tiny light to guide your way. A star to shine bright and watch over you always. You will always be the brightest light in the heavens. A little star away up high is staring at us from the sky. Starlight, Star bright – you are the first star I see at night. Stars are windows to heaven. A little piece of heaven for my little angel. A star for a friend who is “Out of this World.” A nightly reminder of our love and friendship.
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