Simply For Life HRM

Select amount to donate

$25

$50

$75

$100

Or enter an amount

$

Donate

Personal Donation Company Donation

First Name*

Last Name*

Email Address*

Postcode *

Postal Address

Address Line 1 *

Address Line 2

City *

Postcode *

Province *

Country *

Leave a Message (Optional)

Name to appear on page (Optional)

I'd like to remain anonymous to the fundraiser

Credit Card

Name on Card *

Card Number *

Card Expiry *

CVV Number * Donation

$

I’d like to add a little extra to help cover transaction fees. This add-on is optional.

We're fundraising for...

Thank you to our Sponsors

$25

Theresa Rollet

Our Team Members

Stephanie Bendor-Samuel

Theresa Rollet

Raised so far:

$25

Joan Shepard

QEII Health Sciences Centre Foundation

5657 Spring Garden Road
Park Lane Mall, Suite 3005,
Halifax,
Nova Scotia
B3J 3R4

Phone: 902 334 1546
Toll free: 1 888 428 0220
Fax: 902 492 8094
Email:info@qe2foundation.ca

Charitable Business No: 88646 3496 RR0001

QEII Health Sciences Centre Foundation

5657 Spring Garden Road
Park Lane Mall, Suite 3005,
Halifax,
Nova Scotia
B3J 3R4

Phone: 902 334 1546
Toll free: 1 888 428 0220
Fax: 902 492 8094
Email:info@qe2foundation.ca

Simply For Life HRM

Please Help Us
Reach Our Goal

Raised

$25

Our Goal

$3,000

Select amount to donate

Or enter an amount

Postal Address

We're fundraising for...

Thank you to our Sponsors

Theresa Rollet

Our Team Members

Stephanie Bendor-Samuel

Theresa Rollet

$25

Joan Shepard

QEII Health Sciences Centre Foundation

QEII Health Sciences Centre Foundation

Simply For Life HRM

Please Help UsReach Our Goal

Raised

$25

Our Goal

$3,000

Select amount to donate

Or enter an amount

Postal Address

We're fundraising for...

Thank you to our Sponsors

Theresa Rollet

Our Team Members

Stephanie Bendor-Samuel

Theresa Rollet

$25

Joan Shepard

QEII Health Sciences Centre Foundation

QEII Health Sciences Centre Foundation

Please Help Us
Reach Our Goal