YMCA-YWCA of the National Capital Region

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Donation Form

Thank you for choosing to support the YMCA-YWCA of the National Capital Region

Please use this online form to make your secure, charitable donation. An electronic tax receipt will be sent to the e-mail address you provide.

* Denotes required information.

Make a personal donation:
Make a donation on behalf of an organization:

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Title:
* First Name:
* Last Name:

Contact Information


	Home Work

Enter address manually
* Address:

* City/Town:
* Country:
* * * * Province/State:
* Postal/Zip Code:
Phone Number:	( ) Ext.
Cell Phone Number:	( )
* Email Address:

Yes, I consent to receiving the YMCA-YWCA of the National Capital Region's donor e-newsletter and other messages regarding donor events. You may withdraw consent at any time by e-mailing communications@ymcaywca.ca.

Survey Questions

Please direct my gift to:

If other, please specify:

* Is this gift in memory or in honour of someone?

Yes
No

If yes, please tell us the name of the individual you are making a gift in honour or in memory of, and please let us know if you would like us to notify them or their family that a gift has been made. (If you have the family contact information please provide it here.)

How would you like to be recognized?

If you are a member of the Friday Lunch and Discussion Club please check this box.

I am a member of the FLDC

Is this donation part of a pledge that you have previously made?

Yes
No

* How are you affiliated with the Y?

I wish to receive information about leaving the Y in my will.

Yes

Comments:

Payment Information

Pay using Credit Card
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Payment Method:
* * Donation Amount: (Please note, if you select monthly donation the donation amount you enter will be the amount that will be processed each month.)
* Processing Date:
* Number of Installments:
	installments
Pay using PayPal
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* Credit Card Number:
* Card Security Number:	Where is my Card Security Number?
* Cardholder's Name:
* Credit Card Expiration:


* Bank Name:
* Bank ID:
* Cheque Number:
* Transit number:
* Account Number:

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