Donation & Membership Form

Please note that this donation form requires javascript to be enabled. When you submit the form, you will be able to review the information before continuing on to the credit card processing page.

Also note that White Rock South Surrey Hospice Society will never use your email for unauthorized purposes and we will never sell or give email addresses of our donors to third parties.

If you have problems using the form, we can accept your donation by credit card if you phone our office at 604-531-7484. Thank you for your support!

STEP 1. Personal Information

Please complete this field if the donation is on behalf of a company or corporation.

STEP 2. Donation Instructions

Hike 4 Hospice Registration

Please indicate the number of hikers you are registering. Registration is $20 per hiker 18 and over. There is no registration fee for hikers 17 and under.

Note: You will not receive a tax receipt for your registration fee.

In the box below, please specify the name of the individual hiker and/or the team members names and the team name for which you are registering to hike.

Hike 4 Hospice Pledge Details

Please specify the name of the individual hiker or the name of the team to which you would like to pledge.

Other

Please specify what program you would like your gift to be allocated to.

Memorial Gift Information

Please send notification of my memorial gift to:

STEP 3. Donation Amount & Optional Membership

Please accept my donation of:

$ CAD
A $20.00 membership fee will automatically be added to your donation.

STEP 4. Tax Receipt

A tax receipt will be sent to the donor address specified in Step 1 above. If you wish the tax receipt to be sent to a different address, please indicate below.

Tax Receipt Details