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MS - CCSVI Research

Thank you for your interest in supporting MS-CCSVI Research at St. Joseph’s Healthcare Hamilton. Donations of $500 or more will be eligible for a ticket to attend the MS Research Presentation on April 25, 2010 in Toronto, Ontario. Ticket price/donation is $500 for one or $800 for a family of two. A charitable tax receipt will be issued for all donations.

For more information about this event, please contact Amy at 905.522.1155 ext 35949 or by email at amy@stjoesfoundation.ca.

I would like to attend the MS Research Presentation on April 25, 2010 in Toronto. Please sign me up for:

 1 ticket @ $500   2 tickets @ $800

OR

I am unable to attend the MS Presentation, but I would like to make a donation in the amount of:

$25 $50 $75 $100 $150 $200 other:

Donor Information

First Name:
Last Name:
Street Address:
City:
Province:
Postal Code:
Country:
Phone Number:
Email Address:	* (*Presentation details will be forwarded to you via e-mail – please make sure you use a valid address)

	This gift is anonymous.
	Your privacy is important to us. St. Joseph’s Healthcare Foundation contacts its friends periodically to share news and information by mail, phone or email. If you prefer we not contact you, please check this box.

Event Attendees (Please list the names of individuals attending the presentation.)

   

A charitable tax receipt will be issued for all eligible donations. Charitable Business No 11918 3549 RR001

Please click on “Next Step” to proceed to Payment Information

Questions? Email us at info@stjoesfoundation.ca.

I authorize St. Joseph’s Healthcare Foundation to deduct the specified amount from my credit card.