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.

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Title:
* First Name:
* Last Name:

Contact Information


	Home Work

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* * * * Province/State:
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Phone Number:	( ) Ext.
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* 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:

* 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?

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

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No

* How are you affiliated with the Y?

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

Yes

What encouraged or prompted you to make a donation online today?

Comments:

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

I am a member of the FLDC

Payment Information

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* * Donation Amount: (Please note, if you select monthly donation the donation amount you enter will be the amount that will be processed each month.)
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* Number of Installments:
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* Card Security Number:	Where is my Card Security Number?
* Cardholder's Name:
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