Donation/Purchase form | Canadians for Health Research | Les Canadiens pour la recherche medicale

First name:

Last name:

Organization name:

Street:

City:

Postal code:

Province:

Country:

E-mail:

Donate

Donor Level:

Benefactors ($1000+)

Patrons ($500-$999)

Sponsors ($200-$499)

Friends ($25-$199)

To read more about the benefits for each donor level, please check the support CHR page

Other ways to support CHR

Subscription to Future Health:

Regular ($25/year)

Schools/Libraries/Donors ($15/year)

How would you like to receive your subscription?:

I want to receive a copy of Future Health by mail

I want to have access to Future Health articles online, on the CHR website

For online access, your email address should be provided on this form

Subscription to The Diary:

($250/year)

How would you like to receive your subscription?:

I want to receive a copy of The Diary by mail

I want to have access to The Diary online, on the CHR website

For online access, your email address should be provided on this form

A True Story (printed): Quantity $1.50 each, 10 copies or more: $1.00/copy

The Importance of Animals in Research: Quantity $3.50 per set

CHR T-shirts ($10 each):

Small: Small

Medium: Medium

Large: Large

X-Large: X-Large

Receipt: *

Yes

All donations are eligible for income tax receipts upon request only. Please select Yes if you want to receive the income tax receipt.

Would you like to be recognized for your donation by CHR?: :

Yes, I would like the name, website and logo of my organization to be showcased on CHR website

Yes, I would like the name my organization to be mentioned in CHR publications

Only individuals/organizations that donate more then 25$ are eligible for above benefits. Please submit the website URL address and the logo of your organization by email to info@chrcrm.org