Donation form

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DONATION FORM

Thank you for your support!

Please provide the following information to process your donation.
Fields with an * are required.

Title:*

First Name:*

(Please use "and" not "&" if there are multiple names.)

Last Name:*

Company/Organization:

(Please complete if your donation
is on behalf of a company or organization.)

Mailing Address:*

City:*

Province/State:*

Country:*

Postal Code/Zip Code:*

(i.e A1A 1A1)

Phone (home):

Phone (business):

E-mail address:*

Additional Comments:

(maximum 250 characters)

Please send me a tax receipt.
( My contibution will be directed to the CompuCorps Mentoring. )

I am enclosing a cheque payable to:

CompuCorps Mentoring
1040 Somerset St W
Ottawa, Ontario, Canada
K1Y 4L3

Please contact us if you would like further information.

Telephone:(613) 234-8988
Fax:(613) 234-6016
E-mail:info@compucorps.org