Donate to AHPCA Monthly

Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Enter Email Confirm Email
Phone*
How did you hear about AHPCA? Please check all that apply:*
- Visit to our website
- Social Media i.e. Facebook, Twitter
- Friends, Family, Colleagues
- Other
If other please tell us where?*
Is this donation in Memoriam
- Yes
Name In Memoriam
First Last
Would you like an acknowledgement letter sent?
- Yes
Family member to send acknowledgement letter
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Monthly Set Donation Amount
Monthly Donation Amount of Your Choice
Total donation per Month
$ 0.00 CAD
How would you like to make your donation?*
- Online
- Mail in Cheque
Online Donations are processed on the secure PayPal site with a major credit card or through your PayPal account.

You do not need a PayPal account to donate online through PayPal
After clicking on the submit button you will be directed to a downloadable form to print and mail in.

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