Donation Form
You can make a donation for any amount through our secure server using your credit card. All your information is encrypted and transmitted securely to our donations department. A printable receipt suitable for tax purposes will be e-mailed to you after your transaction has been processed. Please check your spam folder after making your donation; receipts could end up in your junk mail.
One-time donation
Amount:
$25
$50
$75
$100
$500
Monthly donation
Amount:
$10
$15
$20
$25
Please debit my
account on the
1st day of the month
15th day of the month
I want to give every month to the Canadian Hemophilia Society. The amount indicated above will be charged on my credit card each month. Withdrawals can be stopped at any time by a simple phone call to the Canadian Hemophilia Society.
Hemophilia Research Million Dollar Club
Amount:
$100
$250
$500
$3,000
$5,000
Purpose of donation
Current research
Endowment
Message
Donation in memory of / in honour of
Amount:
$25
$50
$75
$100
$500
Type of tribute
In Memory Of
In Honour Of
Title
Mr.
Dr.
Mrs.
Ms.
First name
Last name
Name, email or address of the person you wish to be notified. You may include a brief message.
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Contact Us
:
Canadian Hemophilia Society •• 301-666 Sherbrooke Street West, Montreal, Quebec H3A 1E7 •• 1-800-668-2686 ••
[email protected]
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