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Secure Donation

Thank you for your generous support. Your contribution will be used to support quality healthcare in your community.

Please provide the requested information so that we can process your donation. Please be sure to include your email address so that we may send you an e-receipt. If you do not receive your donation receipt promptly due to SPAM filters, please contact christy.wood@hpha.ca and she will re-send your receipt. PLEASE NOTE THAT THE NAME ON THE CREDIT CARD USED FOR PAYMENT WILL BE THE NAME ON THE RECEIPT.

Personal Information

Please provide us with your full name and mailing address.

Title [Mr.Mrs.Ms.Dr.]

First Name *

Last Name *

Mailing Address *

City *

Country *

State/Province *

Zip/Postal Code *

Phone (Day)

In Tribute

If the donation is to be made in memory or in honour of someone, please provide that person's name.

In Memory

In Honour

Target Your Gift

Please tell us how you'd like to direct your gift.

Contribution Amount

Please enter the amount you would like to contribute.

Contribution Amount *

Credit Card Information

Please enter the cardholder name exactly as it appears on your credit card. A tax receipt will be issued using the name of the cardholder. In the case of a corporate gift, please include your name and company as it appears on your company credit card - e.g. Sandra Smith, ABC Company.

Card Type

Cardholder Name *

Credit Card # *

Security Code * What is a CVV2?

Expiry

Email Updates

I would like to receive future communications from the Stratford General Hospital Foundation through email.

Yes

Stratford General Hospital Foundation
46 General Hospital Drive
Stratford, ON N5A 2Y6
Canada