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    One Time Donation Form

    * Required Fields
    Information for Tax Receipt:
    Donor First Name: *
    Donor Last Name: *
    Company:
    Address: *
    City: *
    Province: *
    Postal Code: *
    Phone (xxx-xxx-xxxx): *
    Fax:
    Email Address: *
    Payment Information:
    Pay By: *
    Card Holder First Name: *
    Card Holder Last Name: *
    Credit Card Number: *
    cvv2 Number: * (The 3 digit # at the back of card)
    Expiry Date(MM/YYYY): * /
    Donate Amount: *$
    (Please use whole numbers only with no decimals and comma)
     
    For added security to your on-line donation, please check this box before hitting the donate button.