Donate Now | Peace Arch Hospital Foundation

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Contribution Amount

Please select or enter the amount you would like to contribute.

Contribution Amount *

Personal Information

Email: *

Title [Mr.Mrs.Ms.Dr.]: *

First Name: *

Last Name: *

Middle Name:

Business Name:

Home Address: *

City: *

Country: *

Province: *

Postal Code: *

Phone:

Credit Card Information

Please type the cardholder name as it appears on the credit card.

Card Type

Cardholder Name *

Credit Card # *

Security Code * What is a CVV2?

Expiry

Please note that an official tax receipt will be issued under the cardholder's name. The Income Tax Act
does not permit us to issue tax receipts to anyone other than the donor (the person whose name is on the
credit card).

Additional Information

Please answer the following question..

How did you hear about Walk The Rock? Select the answer(s) that most inspired you to leave your gift.

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