Donate Oops... javascript is not enabled. To use this page your need to enable javascript in your browser. Please click here for simple instructions to enable javascript. Thank you in advance for supporting our Medical Imaging Campaign! Your gift now will help turn our visions into reality. Join with us alongside other Peace Arch Hospital staff and donors! Personal Information To make your donation, simply complete the fields below. Email: Title [Mr.Mrs.Ms.Dr.]: First Name: Last Name: Middle Name: Job Title: Hospital Department: Home Address: City: Country: Province: Postal Code: Home Phone: Work Phone: Phone (Cell): PAH Employee Gender: Female Male Contribution Amount Please select or enter the amount you would like to contribute. Frequency: Contribution Amount: CAD Credit Card Information Please type the cardholder name as it appears on the credit card. Cardholder Name: Credit Card #: Security Code (CVV2): What is a CVV2? Card Type: Expiry: 1 2 3 4 5 6 7 8 9 10 11 12 / 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 MM/YY Please note that an official tax receipt will be issued under the cardholder's name. The Income Tax Actdoes 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 our Medical Imaging Campaign? Select the answer(s) that most inspired you to leave your gift. PAH Staff Emails Hospital Signage or Billboards Social Media Website Word of Mouth Peace Arch News or Thrive Magazine Foundation Event or Presentation Other Recurring message