DONATION FORM


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CERTIFICATES

Donation/Payment Options:

Credit Card
Credit Card Type:MasterCard | Visa
Card Number:
Expiry Date:Month: Year:
Name on Card:
Pre-Authorized Debit (PAD)
For those who wish to have the Meaford Hospital Foundation process a donation directly from their bank account.
CLICK HERE to go to the PAD Form

Donation:

Amount:

Contact Information:

Title:
*First Name:
*Last Name:
Spouse's First Name:
Spouse's Last Name:
*Home Phone:
Business Phone:
ext.
*Mailing Address:
 
*Town:
*Province:
*Postal Code:
*E-mail Address:

TYPE OF DONATION:

One-Time
In Memory Of
In Honour Of
In Memory/Honour Of:
  
Send Acknowledgement To: 
First Name:
Last Name:
Mailing Address:
 
Town:
Province:
Postal Code:

RECOGNITION:

All gifts to the Meaford Hospital Foundation are greatly appreciated. Every donor is recognized in accordance with our Donor Recognition Policy. Please complete the following recognization information For the purpose of recognition, I/we would like our name(s) to appear in the annual

Donor Video Display and the Donor Wall as follows:

Do you wish your donation to remain confidential: Yes | No

All donations are tax deductible. Receipts will be issued, upon payment, for all donations $10.00 and over. Charitable Reg. No. 11903 6408 RR0001

The Meaford Hospital Foundation adheres to high standards governing ethics, privacy and financial management. We do not rent, trade or sell our mailing lists. Personal information, provided by you, is used solely for the purpose for which it was intended and is maintained in a secure manner. You may contact us to remove your name from our mailing list or files.

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