2015 CiTR Fundrive

Please donate now.

Thank you for your support!

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.

* 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:

I give the University of British Columbia permission to contact me by phone, email or mail.

Additional Informational

* Which program do you want to support:

* CiTR will be recognizing donors on our website, in our annual report and in Discorder magazine. I would like my name to appear in donor lists as:

Payment Information

* * Donation Amount:

* Processing Date:

installments

* Credit Card Type:

* Credit Card Number:

* Cardholder's Name:

* Credit Card Expiration:

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