IN MEMORIAM DONATION

A gift given in memory is a very special way to honour or remember a loved one, and we would like to extend our heartfelt thanks for your thoughtful choice of TADH Foundation as the recipient of your donation.

The Foundation will advise the Next of Kin of your donation by providing your name and address (provided we have their contact information).

We do not disclose your donation amount.

Donation

Allocate this donation to:

I would like to dedicate this donation

In Memory of

Notification Details of Card Recipient
Please complete the information below and the Foundation will send a card to the family on your behalf. (Leave blank if no card is required)

First Name ( Card Recipient)

Last Name (Card Recipient)

Address (Card Recipient)

City (Card Recipient)

Province (Card Recipient)

Postal Code (Card Recipient)

Email (Card Recipient)

Provide us with Your Message for the Card Recipient

Your Information

Your First Name

Your Last Name

Company Name

Address

City

Province

Postal Code

Primary Phone

Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our Hospital.

Yes! I'd like to help cover transaction fees so more of my donation goes to our Hospital. I will add $2 and donate $0.00.No. I will donate $0.00 and Timmins and District Hospital Foundation will cover the processing costs.

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.
	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 any time if you wish to discontinue your pledge.