Yes, I want to support Eagle Ridge Hospital Foundation

There are 5 easy steps that need to be completed. Please take a few moments and provide the following information:


Step 1: Choose your Contribution Amount
Frequency:
Contribution Amount:
Currency:

Step 3: Choose your Donation Designation

Dedicate your donation to someone special:


Step 3: Donor Information

Please note according to Canada Revenue regulations Tax Receipts will be issued in the name of the Credit Card Holder.

Email
Email Confirm
Title [Mr.Mrs.Ms.Dr.]
First Name
Last Name
Mailing Address
City
Country
State/Province
Zip/Postal Code
Phone (Day)
Phone (Home/Cell)

In Memory:
In Honour:

Step 4: Payment Information
Cardholder Name:
Credit Card #:
Security Code (CVV2):
Card Type:
Expiry:
MM/YY

An official tax receipt will be issued in the cardholder's name.


Step 5: Additional Information
We love when donors take the time to provide feedback. So please, talk to us!
 

What prompted you to give?
    I received a letter in the mail
    I am a grateful patient/ A family member is a patient
    E-Newsletter
    Newspaper Ad
    Other:

I would like to include Eagle Ridge Hospital Foundation in my will. Please contact me with more information on Planned Giving.
    Yes
    Not at this time
    Other:



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