Thyroid Foundation of Canada
Membership/Donation Form

Thyroid Foundation logo

Awareness - Support - Research

YES! I WILL SUPPORT THE THYROID FOUNDATION OF CANADA!




Thank you for choosing to support the Thyroid Foundation of Canada. Your membership and donations help us to continue our programs of Awareness, Support, and Research.

PERSONAL INFO (as it will show on your receipt)

Title : *
First Name : *
Last Name : *
Address : *
City : *
Province/State : *
Country :
Postal/ZIP Code : *
Telephone :
E-mail : *
* Required fields



MEMBERSHIP:

Membership Type

New membership
Renewal
No Membership

Membership Level:

One Year : Regular/$25 CAD Seniors 65 +/$20 CAD Student/$20 CAD Family/$30 CAD

Two Year : Regular/$40 CAD Seniors 65 +/$30 CAD Student/$30 CAD Family/$50 CAD

Members receive Thyrobulletin, TFC's official newsletter. Please indicate your preference:
By regular mail
By email – email address: As above or:
no Thyrobulletin


DONATIONS:

General Donation: All donations support the work of the Thyroid Foundation of Canada

Please fill in your donation amount only. A total of your membership and donation will be calculated for you on the next screen.

Enter your Donation amount here : $ CAD





OTHER TRANSACTIONS :

Payment for :

Enter Payment amount here :       $

Details/instructions :






RECEIPT:

An official receipt for income tax purposes will be issued for all membership fees and donations. (BN: 11926 4422 RR0001)

Please choose your preferred receipt type :





PAYMENT INFORMATION

Amount: $0.00
Credit Card: VISA MASTERCARD
Credit Card Number:
Expiry Date:
Name on card:


Thyroid Foundation of Canada
P.O. Box 298
Bath ON K0H 1G0
CANADA

Tel: 1-800-267-8822

An official receipt for income tax purposes will be issued for both
membership fees and donations.
(BN: 11926 4422 RR0001)

Thank you for your support.

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