DI Donation Form

Thank you for your support! Large or small, your donation is a vote of confidence in our work, and will make a difference.

Donation Amount *

Yes! I would like to receive DI's FREE monthly e-newsletter

Personal Info

First Name *

Last Name *

Company Name (if applicable)

Street Address *

City *

Province *

Post Code *

Phone Number *

Email *

Payment Info

If you wish to pay by card, upon submission of this form, our administrator will send you an online payment form directly to your email address.

Or if you wish to pay by Interac e-transfer, kindly transfer the amount to vbs@telus.net and include your Full Name in the Message box.

How would you like to pay? *

Credit/Debit Card

Interac E-Transfer

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Address for tax receipt is different than above

Street Address for tax receipt

City

Province

Postal Code