Your Donation

REQUIRED FIELDS ARE MARKED WITH AN ASTERISK ( * )

Fund*
  • Patient programs & education
  • Research
Donation Amount*
  • $25
  • $50
  • $100
  • $250
  • $500
  • Other $
Do you want your donation to remain anonymous?
  • Yes
  • No

Your Information

Language of preference*
  • English
  • French
Email*
Confirm Email*
Daytime Telephone*
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
I would like to receive Kidney Cancer Canada's e-Newsletter
  • Yes
J'aimerais recevoir le bulletin d'information de Cancer du Rein Canada
  • Oui

In Memory or In Honour Donation

Would you like to dedicate this donation?
  • Yes, In Memory of Someone
  • Yes, In Honour of Someone
  • No
If YES, please enter their name:
Would you like us to send an acknowledgement card?
  • No Thank You
  • Yes, please send a card to:
First Name
Last Name
Address
City
Province
Postal Code
Country
Message to include on card:

Payment Information

Amount*
$
Name on Card*
Card Number*