FIBROMYALGIA SOCIETY OF ONTARIO INC. RR # 1, Site 15, Box 10, Mindemoya ON P0P 1S0 Ph: (705) 377-4110       Fx: (705) 377-4110 Email: fibromyalgia_on@yahoo.com FORM FOR DONATIONS ( A receipt will be issued for income tax purposes for all donations ) Name: ________________________________________________ Address: ______________________________________________ City: __________________________ Postal: _________________ Phone: _______________________ Email: _________________________________________________ DONATION: _______________ please make cheque payable to The Fibromyalgia Society of Ontario Inc. RR # 1, Site 15, Box 10 Mindemoya, ON, P0P 1S0