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Gift by Mail or Fax - Gift In Honour


Please print this form and mail or fax it to us.

Multiple Sclerosis Society of Canada
175 Bloor Street E., Suite 700, North Tower
Toronto, ON  M4W 3R8
Fax: 416-922-7538

Asterisk (*) indicates required information

Personal Information

Title:                                               
*Address:                                               
                                                
*Postal Code:                                               
Telephone: (         )                                  
*E-mail:                                               
*Name:                                               
*Town/City:                                               
*Province:                                               
*Country:                                               
Fax: (         )                                  
When you join the fight against multiple sclerosis you will receive the most recent newsletter updates and personalized name and address labels. Please click here if you do not wish to receive our newsletter and personalized address labels.

Card Recipient's Information

Title:                                               
*Address:                                               
                                                
*Postal Code:                                               
*Name:                                               
*Town/City:                                               
*Province:                                               
*Country:                                               

Donation Information

*I would like to make a single gift donation of: *Receipt type preference:
$20 $25 $50 Other amount $                  E-receipt Mail receipt
Please direct my gift to: Tax receipts for donations under $10 will be provided upon request. My donation is under $10 and I would like to receive a tax receipt.
Research Services Greatest Need
*Please select the greeting to be printed on your card: In the card, please identify me:
your graduation
your anniversary
your wedding
the holiday season
the New Year
your birthday
Christmas
Easter
our friendship
your retirement
your thoughtfulness

By name only
By name and address
As follows:

                                                             

Payment Information

*Card Type: Visa MasterCard American Express
*Card Name:                                             *Card Number:                                            
*Expiry Date: (mm)               /(yy)