Donate
WE NEED YOU NOW!
OUR COMMUNITY IS IN CRISIS AND THE STAKES COULD NOT BE HIGHER.
This is a defining moment. The choices we make now, will define us for years to come.
* My gift is:$
* Payment Type
Single Payment 
Monthly Payments 
Type of Gift
* Personal or Corporate
I want to make a personal donation 
I want to make a donation on behalf of a company 
Personal Information
Title
* First Name
Maiden Name
* Last Name
Date of birth
/ /
Gender
Male Female 
Preferred Language
English French 
CJA account
This number can be found in your statement. Note for first time donors: an account number will be assigned automatically
Apt.
* Province
* Postal Code
* City
Primary Phone
* Phone
Primary Email
* E-mail
A valid e-mail address is required in order to process your gift
Credit Card Information
* Credit Card Number
Please do not enter spaces
* Cardholder's Name
This form will only issue a tax receipt under the card holder's name.
* Card Type
* Expiry Date
/
* Verification Number
The VISA or MasterCard verification number is a 3-digit number printed on the back of your card. The American Express verification number is a 4-digit number printed on the front of your card.
Total $ 0.00
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