Give in Memory / in Honour - Alzheimer Society Southwest Partners

Give today Yes, monthly In honour / In memory

Tribute Donation

Thank you for choosing to make a gift to support programs and services in Elgin, Middlesex, and Oxford.

Field Is Required Enter a Gift Amount:

$250

$100

$50

$25

Other:

Enter amount

I would like to make this an anonymous donation.

Field Is Required I would like my donation to support:

Tribute Information

Gift Type:

Who is this gift in honour or in memory of?

Title:

First Name:

Last Name:

Who is this tribute donation from?

Should we notify someone of your gift?

Card From Name

Mail a Printed Card

Recipient First Name:

Recipient Last Name:

Send an Electronic Card

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

The name and address you enter below must match your credit card details in order to process this donation. The Canada Revenue Agency (CRA) does not permit us to issue tax receipts to anyone other than the donor (the person whose name is on the credit card).

Make this gift on behalf of an organization (check this box for organization gifts)

Organization Name: