Mother's Day Fundraiser Order Form
Date of pick-up/delivery: Saturday, May 12th
Time of Pick-up/Delivery: 12:00pm - 4:00pm
Cost: $25 (small - individual) & $45 (large - family) - Free delivery available within Regina City limits
Deadline to order: Wednesday, May 9th

New in 2018: Option to purchase a basket for a mother in need! This year we have partnered with the YWCA, Sofia House, and Regina Transition House to provide baskets to mothers in our community.

First and Last Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Number of small baskets you would like to purchase ($25) *
Number of large baskets you would like to purchase ($45) *
Total *
Total dollar value of purchase
Your answer
Delivery or Pick-Up *
Method of Payment *
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