Member Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Membership Information

Please note this form is intended for the purchase of individual memberships for 2017. Please use a separate form for each person who would like to become a member.

 

If you would like to buy a membership for any other year or if you are unsure if you are already a member please contact Hospice Halifax at 902-446-0929.

 

While the cost of membership is not tax deductible, please consider making a donation with your membership which you can claim on your tax return.  

Quantity
Price
Total
Membership 2017

Membership for 2017

X
$
20.00=
$
0

$5 donation
X
$
5.00=
$
0

$10 donation
X
$
10.00=
$
0

Final Total:
$
0

Payment Information

Amount*
$
Name on Card*
Card Number*

Security Code