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Personal Information

Salutation

Select Ms. Mr. Mrs. Dr.

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

Province/Territory *

Postal Code *

Country

Telephone

Email Address *

Can we send your receipt by email?: *

Yes
No

Payment Method

1. If paying by cheque or money order:

Please print and mail this completed form along with your cheque made payable to CNF to:

Canadian Nurses Foundation
50 Driveway
Ottawa ON K2P 1E2
or send it by fax to : 1-613-237-3520

2. To pay by secure online credit card:

My total contribution is :*

Donation Type :*

'In Memoriam' Donations

First Name of the deceased

Last Name of the deceased

A receipt will be issued for income tax purposes for all in memoriam donations

If you would like us to mail an In Memoriam card to the next-of-kin acknowledging your donation,
please provide us with the next-of-kin's contact information.

First Name

Last Name

Address 1

Address 2

City

Province/Territory

Postal Code

Thank you for your donation.
We are very grateful for your support!