als Logo

Sponsor Rick Shaver

     

Thank you for your generous support

Please provide your contact and payment information below. Your contact information is required to generate an electronic tax receipt which will be sent to the email address that you provide.

* denotes required information




*
*


Contact Information


*
*
*
* * *
*
( ) Ext.
( )
*


Display Name

Payment Information


* * Donation Amount:
* Processing Date:
*
installments
*
*
*
*
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.

PRIVACY STATEMENT
The ALS Society of Canada respects your privacy. We protect your personal information and adhere to all legislative requirements with respect to protecting your privacy. The information you provide on this form will be used to keep you informed and up to date on the activities of the ALS Society of Canada, including newsletters, programs, services, events, donations and opportunities to volunteer – this information will not be sold or traded with third party organizations. Please notify us of any changes by phone at 1-800-267-4257 or via email at info@als.ca, and we will gladly accommodate your request.