1. science
2. medicine
3. surgery
4. transplants

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.