Donate Test - Lions Foundation of Canada Dog Guides

Select the type of fellowship or membership: *

Quantity *

Name of recipient as it will appear *

Language for Fellowship or Membership *

English
French

Name of recipient as it will appear (2) *

Language for Fellowship or Membership (2) *

English
French

Name of recipient as it will appear (3) *

Language for Fellowship or Membership (3) *

English
French

Name of recipient as it will appear (4) *

Language for Fellowship or Membership (4) *

English
French

Name of recipient as it will appear (5) *

Language for Fellowship or Membership (5) *

English
French

Presented by (as it will appear) *

Lions Club District (if applicable)

Contact person

Full name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone Number *

Comments

Total

Payment Information

Method of payment

Credit card
Cheque
Other

Credit Card

Card

Name on Card

Paragraph Text

For Cheques: Make cheques payable to: Lions Foundation of Canada Dog Guides. Please send your payment to: Lions Foundation of Canada Dog Guides Att: Memorial Forest. 152 Wilson St., Oakville, L6K 0G6