www.dystonie-qc.org
Mailform
     Dernière mise à jour / Last Update: 21/11/12 ( 04:23:49 )

Mailform

You can send us a donation via this form ...

1. Enter the information requested on the form below.

2. We will send a card to the family to inform them of your gift (donation amount undisclosed).

3. An employee of Dystonie-Quebec will call you tomorrow (or next business day)
to finalize your donation. You can also use the services of CanadaHelps to send donations,
you will find the link at the bottom of this page, BUT please first send us this form by clicking on the button Send .

42300
Repeat this number




Name of deceased :


Name of donater :

Address :

City :

Postal Code :

Telephone (xxx) xxx-xxxx :

Sender e-mail :

Donation $ :

canadahelps.org

Dystonie-Québec (www.dystonie-qc.org)
Support, Education, Information