IRSSS Donation Form

IRSSS Donation Form
Who is making the donation?
Name/Organization
Would you like to make this donation monthly?
Name

First NameLast Name
Donation Amount ($5, $10, $20, Other)

prevnext( X )
CADDonation
The Canada Revenue Agency requires that donation receipts bear the name and address of the actual donor.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Do you require a receipt for your donation?
Should be Empty: