Donation Form

You can make a donation for any amount through our secure server using your credit card. All your information is encrypted and transmitted securely to our donations department. A printable receipt suitable for tax purposes will be e-mailed to you after your transaction has been processed. Please check your spam folder after making your donation; receipts could end up in your junk mail. 
* Required fields
Type of donation
  
Type of donation
 
     
  


Personal information
  Title 
* First name 
* Last name 
  Company 
* Address 
* City 
* Postal code / Zip 
* Province / State 
* Country 
* Telephone 
  
Work phone
 
* E-mail 
   



Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly debited to your account.

Contact Us:Canadian Hemophilia Society •• 301-666 Sherbrooke Street West, Montreal, Quebec H3A 1E7 •• 1-800-668-2686 •• chs@hemophilia.ca


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