Individual Donation

Salutation:
Dr.   Mr.   Mrs.   Ms.  
First Name:
 *
Last Name:
 *
Address Line 1:  *
Apt/Suite:
City:  *
Province / State:
Postal Code / Zip:  *
Country:
Phone:  *
Email (for receipt):
 *
Donation Amount (CAD):  $50
 $100
 $150
 $200
Or Other Amount $:  *
Amount should be only in numbers
We incur a small processing fee which is deducted from the full amount of your donation. Would you consider paying this small fee on behalf of Kinsmen Lodge?
Include Fee: Yes   No
Total:
$  
Donate Anonymously?:
How did you hear about us? (choose one):
If 'Other', please specify: