Butterfly for donation form

YOUR GIFT BRINGS HOPE 
to thousands of Canadians who are affected by pancreatic cancer each year.

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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Please Select A Gift Amount: Please Select A Gift Amount: Required radio button group.
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Choosing this option will automatically repeat this gift transaction every month. Required
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In Memory or Honour Donations and Notification Options

By checking the following tribute box, a form will appear ... you can enter the name of the honoree and who you would like us to notify of your gift along with their contact information

 
Please provide the name of the honoree and the family member you wish to notify Please provide the name of the honoree and the family member you wish to notify Required
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List Your Gift On The Tribute Wall
List Your Gift On The Tribute Wall

 
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Donor Billing Information

The Canada Revenue Agency requires that donation receipts bear the name and address of the actual donor. Your official tax receipt will be e-mailed to you immediately.

* The billing address you provide must match the billing address that is on file with the financial institution that has issued the credit card.

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For your privacy, subscribers can unsubscribe using any email or login to change communication preferences. For your privacy, subscribers can unsubscribe using any email or login to change communication preferences. Required
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