Donate to BCERF
 

Please print the following form.

Fill it out and mail it with your check or money order
(or your Visa or Mastercard account number) payable to:

BC Endocrine Research Foundation
281-828 West 10th Avenue, Vancouver B.C., V5Z 1L8
fax: (604) 875-5931 tel:(604) 875-5922

Yes, I wish to support the BC Endocrine Research Foundation.
This gift is eligible for an income tax credit.

Name:__________________________________
Address:_________________________________
City/Town:_______________________________
Province:____________Postal Code:__________
Telephone  # :______________________
Please accept my contribution of :
check box $ 1000 check box $ 500 check box $ 250 check box $ 100
check box $ 75 check box $ 50 Other $____________
Donors of $ 20 or more will automatically receive the Quarterly Newsletter.
Please direct my contribution to the following Research/Education Fund:
check box  Diabetes check box Heart Disease check box Osteoporosis
check box Lipid/Cholesterol check box  Hypertension check box Thyroid Disease
check box Hormone Replacement Therapy check box General check box Menopause

If paying by Visa or Mastercard, please provide:
Card   #__________________Expiry:_______
Signature:____________________________

Enclosed with this form is a cheque/money order payable to and sent to :
The BC Endocrine Research Foundation