Direct Donation

Donate Now

Thank you for choosing to support the Alzheimer Society of Alberta and Northwest Territories.

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.

* Denotes required information.

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

Connecting to Facebook, please wait...

* First Name:
Middle Initial:
* 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:
Your support matters to us, so Alzheimer Society Alberta & NWT would like to use your information to keep in touch about things that may matter to you. If you would rather not hear from Alzheimer Society Alberta & NWT, you can unsubscribe using the checkbox below.
I do not give Alzheimer Society Alberta & NWT permission to contact me by email.

Donation Type

* I would like my donation to be directed to:

Greatest Area of Need
Programs & Services
Research

* Would you like to make this donation in honour or in memory of someone?

Add a message to the Alzheimer Society (optional)

Matching Gift

Your employer may match your gift. Enter your employer name below to see if your company offers matching gift.

Sorry, no results were found. Please check the spelling and try again.

Sorry, the Search has timed out.

Payment Information

Pay using Credit Card
Card Security Number is not supported in data entry. To process a credit card payment, you need to disable Card Security from the Electronic Payment page in the Configuration tab.
Payment Method:	One Time Payment Credit Card Monthly Payments Credit Card
* * Donation Amount:	Donation of $25 Donation of $50 Donation of $100 Monthly donation of $10 Monthly donation of $25 Monthly donation of $50 Monthly donation of $100 Donation Amount Monthly donation
Did you know that by covering the processing fee, Alzheimer Society Alberta & NWT will be able to help more people?
I want to cover the fees for my donation ( %ProcessingFee% ).

* Processing Date:
	installments
Pay using PayPal
* Credit Card Type:
* 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:

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.

Cookie Policy