Thank you for making a donation to the Heart and Stroke Foundation. If you have any questions please call us at 1-888-HSF-INFO (1-888-473-4636).
2012 Heart Month Campaign I am enclosing a one-time donation of: $35
$50
$100
$250
Other:
Mr.
Mrs.
Ms
Dr.
Other:
First Name: _______________________________ Last Name: Address: _____________________________________________________ Suite: City: ______________________________________ Prov/State: ________ Postal code/ Zip: Country: __________________________________ Home telephone:
Cheque or money order payable to: Heart and Stroke Foundation Please charge the above amount to my credit card (please complete credit card information below)
Credit Card Information: Visa
Mastercard
American Express
Name on card: Card Number: ________________________________________________ Expiry Date: Signature:
Type of Donation: Is your donation sponsoring a specific participant or event?
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Name of participant (if applicable): Name of event (if applicable):
Thank you for supporting the Heart and Stroke Foundation. Please mail or fax this form to the Heart and Stroke Foundation office in your province. Mailing and fax information can be found on page 2 of this form.
Heart and Stroke Foundation – Provincial Mailing Addresses Please mail or fax your completed form to the Heart and Stroke Foundation office in your province.
Alberta
Newfoundland
Heart and Stroke Foundation of Alberta, NWT & NU100-119 14 Street NW Calgary, Alberta, T2N 1Z6 Fax: (403) 237-0803
Heart and Stroke Foundation of Newfoundland & Labrador 169-173 Water Street, P.O. Box 5819 St. John’s, Newfoundland, A1C 5X3 Fax: (709) 753-3117
British Columbia Heart and Stroke Foundation of BC & Yukon 1212 West Broadway Vancouver, British Columbia, V6H 3V2 Fax: (604) 736-8732
Prince Edward Island
Nova Scotia Heart and Stroke Foundation of Nova Scotia 5161 George Street, 7th Floor Halifax, Nova Scotia, B3J 1M7 Fax: (902) 492-1464
Ontario
Heart and Stroke Foundation of Prince Edward Island 40 Queen Street, P.O. Box 279 Charlottetown, Prince Edward Island, C1A 7K4 Fax: (902) 368-7068
Heart and Stroke Foundation of Ontario P.O. Box 7008, Station Main London, ON, N5Y 5W7 Fax: (519) 963-0995
Manitoba
Quebec
Heart and Stroke Foundation of Manitoba Suite 200, 6 Donald Street Winnipeg, Manitoba, R3L 0K6 Fax: (204) 957-1365
Heart and Stroke Foundation of Quebec 1434 Sainte-Catherine Street West, Suite 500 Montreal, Quebec, H3G 1R4 Fax: (514) 871-9385
New Brunswick
Saskatchewan
Heart and Stroke Foundation of New Brunswick 133 Prince William Street, Suite 606 Saint John, New Brunswick, E2L 2B5 Fax: (506) 648-0098
Heart and Stroke Foundation of Saskatchewan 279 - 3rd Avenue North Saskatoon, Saskatchewan, S7K 2H8 Fax: (306) 664-4016