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Yes, I support the Children's Health Centre at Surrey Memorial Hospital!

Please take a moment to provide the following information. There are 5 easy steps that need to be completed.

Please note: items marked with a red line () are required fields.


Step 1: Donation

Yes, I want to support innovative child health care in Surrey!

 


Please select your contribution amount, or enter a different amount in the box below. The minimum amount is $5 or more to save on administration costs. Gifts of $20 or more will automatically receive an official receipt for income tax purposes. 

Frequency:
Contribution Amount:
CAD

Step 2: Donor Information
Email
Title [Mr Mrs Ms Dr]
First Name
Last Name
Company
Mailing Address
City
Country
Province
Postal Code
Telephone

Step 4: Payment Information

Please type the cardholder name exactly as it appears on your credit card. An official receipt for income tax purposes will be issued to the individual or company (for corporate gifts) named on the credit card. In the case of a corporate gift, please include your name and company name as it appears on your company credit card – e.g. Jane Smith, ABC Company.

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

Step 5: Additional Information
E-newsletter:
    Yes, I want to receive Foundation news every other month by email.

By submitting this form, you agree with and accept our Privacy Statement.  Consistent with our Foundation Board policy, a 20% contribution from all designated donations will support the work of Surrey Hospital & Outpatient Centre Foundation.



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