Donation in Support of Cancelled Ball

1 Amount

2 Your Information

3 Payment

1-Donation
Yes, I would like to replace the purchase of my Ball ticket with a donation of:*
- $200
- $400
- $600
- Other
Enter donation amount:**
Total Donation
$ 0.00 CAD

3 - Payment
Billing Information*
This address will be used for the tax receipt.

Use previously entered address

Street Address Address Line 2 City Province Postal Code
- For donations lower than $20, click here if you wish to receive a tax receipt
Payment Method*
- Credit Card
- PayPal
*After you hit "submit" you will be taken to PayPal to complete your payment*
Credit Card Information*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Summary
**Please confirm that all information is correct.**

Name: {Name (First):32.3} {Name (Last):32.6}
Company Name: {Company Name (First):33.3}
Address: {Address (Street Address):34.1} {Address (Address Line 2):34.2}, {Address (City):34.3}
{Address (State / Province):34.4} {Address (ZIP / Postal Code):34.5}
Telephone: {Telephone:35}
Email: {Email:36}

Donation amount: {Total:45}
Total
$ 0.00 CAD
Phone
This field is for validation purposes and should be left unchanged.

1-Donation