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.

Please choose one:

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: Members receive Thyrobulletin, TFC's official newsletter.
Membership referred by (name):

Membership Level:

One Year :


Two Year :

Enter your Membership amount here: $ CAD




DONATION:

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

Enter your Donation amount here: $ CAD





OTHER PURCHASES: Payments other than Membership and Donations (No official tax receipt)

Payment for:

Enter Purchase 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:

Amount: $0.00
Donation: $0.00
Other: $0.00
Total Amount: $0.00
Credit Card:
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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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