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Thank you for supporting DMRF.

This form will allow you to make an In Memoriam or Tribute Gift in honour or celebration of someone special. Your donation will support of life-changing medical research taking place here in the Maritimes. We are grateful for your generosity. Electronic income tax receipts are issued for donations of $10.00 and up.

This giving option will allow you to send notification of your gift via email or card to the person or persons being recognized, or to the family of the loved-one being honoured. You will be prompted as you follow the steps below.

Please continue to complete your secure donation.

In Memoriam or Tribute

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

In Memory of:
Pay Tribute to:

Please provide the full name and address of anyone you would like notified of your gift; along with any comments you would like to share.

Email:

Full Name:

Mailing Address:

Message:

Personal Information

If you would like to receive a tax receipt for your donation, please provide all of the requested information.

Email Confirmation

Title [Mr.Mrs.Ms.Dr.]

First Name

Last Name

Organization or Company Name

Mailing Address

City

Country

State/Province

Zip/Postal Code

Phone (Day)

Contribution Amount

I am making an immediate gift of:
** For your security, donations over a set value may prompt an error message and cannot be processed via our website. If you encounter this error, please contact our office at 902-494-3502 to complete your donation by phone.

Frequency:

Contribution Amount:

CAD

Credit Card Information

Please type the cardholder name as it appears on the credit card. (Please note that receipts are issued in the cardholder name)

Cardholder Name:

Credit Card #:

Security Code (CVV2):

What is a CVV2?

Card Type:

Expiry:

MM/YY

What inspired you to give to DMRF?
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Please send us a message. We appreciate any feedback. Thank you!

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