Step 1: Personal Information (* indicates required fields)
Salutation:    *First Name:    *Last Name:
*Street Address:



*Postal Code:

Company Name: (for corporate donations only)
Step 2: Tax Receipt should be made out to (Leave this section blank if same as above)

First Name:

Last Name:

Corporate Name:

(for corporate donations only)
Step 3: In Tribute
This gift is in memory of:
This gift is in honour of:  
Please provide the full name and address of person you would like notified of your gift, along with any comments you would like to share:






Postal Code:

Acknowledgment Message:
Donations to the Delta Hospice Society support the Harold & Veronica Centre for Supportive Care and Irene Thomas Hospice.
Step 4: Donation
*Please accept my contribution of: $50 $100 $200 Other - Amount $
Frequency:  One Time   or    If you would like to become a monthly donor, please contact Delta Hospice Society at 604.948.0660

Donations to Delta Hospice Society are tax deductible. A tax receipt will be mailed to you for donations of $25 or more. Charity Registration No. 132728536RR0001
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If you experience any problems with this form, please call the Care Centre at 604-948-0660 and someone can take donation information over the phone.

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