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To reach the hospital, please call 514.630.2225
Lakeshore General Hospital Foundation
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General Donation Form

  • DONOR INFORMATION

  • TYPE OF GIFT

  • TYPE OF DONATION

  • PAYMENT METHOD - Single Donation

  • PAYMENT METHOD - Monthly Donation

  • Price: $ 1,000.00 CAD
  • Price: $ 500.00 CAD
  • Price: $ 250.00 CAD
  • Price: $ 100.00 CAD
  • Price: $ 50.00 CAD
  • Price: $ 20.00 CAD
  • Price: $ 15.00 CAD
  • Price: $ 10.00 CAD
  • Payable on the 1st day of each month. If the 1st is a Saturday, Sunday or statutory holiday, your donation will be processed on the following business day. A receipt for income tax purposes will be mailed to you at the beginning of the next calendar year. You may modify or discontinue your monthly donations at any time. Please inform us by phone at 514-630-2081 at least seven (7) business days before the scheduled date of your next gift, so that we can ensure that no additional donation is processed.
  • PAYMENT METHOD - Monthly Donation

  • PAYMENT METHOD - Single Donation

  • (Please note that for amounts under $25, receipts are sent upon request )
  • Direct Debit Withdrawal

  • Or write a cheque to the Foundation with VOID written on it

    The Lakeshore General Hospital Foundation
    160 ave. Stillview, suite 1249
    Pointe-Claire, Québec
    H9R 2Y2
  • Credit Card Payment

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  • Summary

  • **Please confirm that all information is correct.**

    Name: {Name (First):1.3} {Name (Last):1.6}
    Company Name: {Company Name (First):87.3}
    Address: {Address (Street Address):2.1}, {Address (City):2.3}
         {Address (State / Province):2.4} {Address (ZIP / Postal Code):2.5}
    Telephone: {Telephone:3}
    Email: {Email:4}

    Type of gift: {Please select the type of gift you would like to make with your donation::16}
    Donation purpose (if specified): {Specify which Fund, Department or Community Event::17}

    {Please select the type of General Donation you would like to make::12}
    Donation amount: {I would like to make a donation in the amount of::38} {I would like to make a monthly donation in the amount of::72} {Enter your Donation::44}

  • $ 0.00 CAD
  • Share your Story

  • Should your generosity be a testament of your hospital experience, or that of a loved-one, and if you care to share your story, please feel free to contact us, as we cherish your feedback.

  • This field is for validation purposes and should be left unchanged.


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