Donate

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
*A tax deductible receipt will be issued
Note: Please print and mail to the above address.