by cheque- please print this page,
by credit card - please click on "Donate Now"
Donor`s Name:_____________________________________
Address:__________________________________________
__________________________________________
Postal Code:___________________
This gift is in memory / honour of: ______________________
Please notify the following person of this donation:
Name:___________________________________________
Address:_________________________________________
_________________________________________
Postal Code:___________________
*$25 *$50 *$75 *$100 *$250 *$500 *$1000 *$1000+
Manitoba Prostate Cancer Support Group
Box 315-971 Corydon Ave.
Winnipeg, MB.
R3M 3S7
Charity number: 88907 1882 RR001