Donate in memory/tribute - Alzheimer Society of Canada

Your support is a lifeline to families affected by dimentia. Brad, caregiver to his mom.

☑ Yes, I want to help fund critical research and support programs by making a:

One-time gift

Monthly gift

Gift in memory/tribute

One-time gift

Monthly gift

Gift in memory/tribute

Please match my gift of:

Field Is Required Enter A Gift Amount:

$150

$100

$50

$25

Other:

Enter amount

I would like to remain anonymous in any public recognition of this donation. Please note that donations of $1,000 or more are acknowledged in our Annual Report.

Gift type

Select gift type:

Who is this gift in honour / memory of?

Title:

First Name:

Last Name:

Should we notify someone of your gift?

Card From Name:

Mail a printed card

Recipient First Name:

Recipient Last Name:

Yes, I would like to send an eCard.

eCard Subject:

Personal Message:

Please note your personal message cannot exceed 255 characters.

Recipient Email Addresses:

Select an eCard:

Send eCard on:Select month of credit card Select Expiration Year

Yes, send me a copy of the eCard.

Recipient Address (line 1):

Recipient Address (line 2):

Recipient City:

Recipient Province/State:

Recipient Postal/ZIP Code:

Recipient Country:

Donor billing information

Please note that the address you provide must match the billing address of the credit card holder. If it does not, please contact donorserve@alzheimer.ca. The Canada Revenue Agency requires that donation receipts bear the name and address of the actual donor.

Title:

First Name:

Middle Name:

Last Name:

Address (line 1):

Address (line 2):

City:

Province / State:

Postal / Zip Code:

Country:

Phone number:

Email Address:

Yes, I'd like to receive news, tips and information by email from the Alzheimer Society.

Planned giving

Please send me information on how to leave a gift in my will.

Donor payment information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

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RE Fund