ALS Society of Manitoba

Please support the ALS Society of Manitoba

Please provide your contact and payment information. The contact information is required to generate a tax receipt. The electronic tax receipt will be sent to the email address that you provide.

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Contact Information


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Phone Number:	( ) Ext.
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* Email Address:

Allow ALS Society of Manitoba to contact me by email.
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Survey Questions

* Please indicate what type of donation this is.

You will have an option to send an e-card once your donation is processed. If you prefer we send an acknowledgement on your behalf please provide the name and mailing address of the person to receive the Acknowledgement Card for the in Memory donation if applicable.

Payment Information

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Did you know that by covering the processing fee, ALS Society of Manitoba will be able to help more people?

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* Number of Installments:

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* Credit Card Number:

* Cardholder's Name:

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Security Check

We have implemented an extra step in order to prevent Credit Card fraud. Unfortunately, some people use automated programs to test whether fraudulently obtained credit cards are valid. To counteract this practice we ask that you answer the question below.

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