Alzheimer's Society
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Gift Information

Field Is Required Select A Gift Amount:

Gift Recognition

If you are making a donation on the behalf of someone else, please enter their name below.

You can also use this field to record how you would like your donation to appear on the recipients donor wall (eg. John Smith, or Smith Family for example).

Donor Billing Information

The email address entered MUST belong to that of the donor in order for the receipt to be issued in the donor’s name. If you do not have the donor’s email address, please use the email format in order to have the receipt sent via Canada Post: (example:

Donor Payment Information

Credit Card Information:

Credit Card Type:
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