Please Donate Now

With your donation, we will continue to raise awareness and encourage people to get screened. Don't Die of Embarrassment.

Please help us get the word out.

Personal Information
Title [Mr.Mrs.Ms.Dr.]
First Name
Last Name
Mailing Address
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:

Contribution Amount
Please enter the amount you would like to contribute.
Contribution Amount:

Credit Card Information

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 or company whose name is on the credit card).

Cardholder Name:
Credit Card #:
Security Code (CVV2):
Card Type:

Please send us a message. We appreciate any feedback. Thank you!

Powered By