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Would you like to make a gift or a donation? Donation Gift
Donation in the amount of:
Choose... $25 $50 $75 $100 $250 $500 $750 $1,000 OR
Donation in memory of:
Next of Kin Notification Name:
Next of Kin Notification Address:
I want to make a Gift in Kind of:
With a retail value of:
I want to make a one-time
I would like to give monthly pre-authorized donations in the amount of
...and I want to make the payments Choose...MonthlyYearly
Please issue a tax receipt Choose... Yes No Name for tax receipt:
Name as it appears on card:
The receipt will be issued to the name on the credit card
Card Number:
Expiry Date:
Card Type:
Title:
First Name:
Middle Initial:
Last Name:
Company:
Street Address:
City:
Province/State:
Postal Code:
Country:
Canada USA
Email address:
Phone (Home):
Phone (Work):
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