Donation Form

Monthly donation form

Thank you for your monthly donations! Here is what you provide as a monthly donor:

A strong message of support for families struggling with mental illness in a loved one
A vote of confidence in our work
A voice for anti-stigma surrounding mental health
A reliable source of income
A reduction in administrative work and costs for us

You will receive a tax receipt for your initial amount immediately and then a cumulative tax receipt for all other donations each January. As a thank you, we renew your membership for as long as you are a monthly donor.

For any questions, or to change the amount you donate, email Diana: [email protected].

We appreciate your support. Please complete the form below.

Contact Information

First Name

Last Name

Company Name

Address

City

Province

Postal Code

Phone

How do you want to receive our quarterly newsletter?

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

Province

Postal Code

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment. We never share, trade, or sell donor information.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.