Donation Form |
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Please print and complete the following information.
By providing this information you consent for the Journey to Heal Foundation (JTH) to collect, disclose, and use it for follow-up contacts, statistical purposes, and to process and recognize donations. Information will be disclosed to employees and agents of JTH as necessary to accomplish these purposes. Name, and contact information are optional. If you do not wish to be identified please enter “Anonymous” for both the first and last name. Tax receipts will be issued for any donation exceeding CAD$20. Tax receipts cannot be issued to anonymous donors.
| Title | __________ |
| First Name | ________________________________________ |
| Last Name | ________________________________________ |
| Organization Name (if applicable) |
________________________________________ |
| Address Line 1 | ________________________________________ |
| Address Line 2 | ________________________________________ |
| City | ________________________________________ |
| Province | __________ |
| Postal Code | __________ |
Please provide us with a phone number or e-mail address to ensure we have a means of contacting you if we have a question regarding your donation.
| Phone Number | (_____) _____-______ Ext._____ |
| Fax Number | (_____) _____-______ |
| ________________________________________ | |
I would like to make a donation to the Journey to Heal Foundation in the amount of (circle one or fill in your desired amount):
| $20 | $35 | $55 | $100 | Other: $_____ |
I would like my donation to be (circle one): One-time donation / Monthly donation*
*For monthly donations, please attach a cheque marked VOID.
Payment method (circle one):
| Visa | MasterCard | AmEx | Cheque | Cash |
| (make payable to "A Journey to Heal Foundation") |
Credit card payment information:
| Card Number | ________________________________________ |
| Expiry Date | _____/_____ |
| Signature | ________________________________________ |
Please use the following information when mailing your donation:
A Journey to Heal Foundation
60 Afton Cres.
Maple, Ontario
L6A 1H5
Thank you for your support.
Let us Build a Future Without TTP!