Yes, I'd like to donate
Donation Amount*
$20
$50
$100
Other $
Donation Frequency*
One Time
Quarterly
Monthly
Fund*
Where it's Needed Most
Variety's Special Needs Program
Variety's Camp Brereton
Variety's Dental Outreach Program
Corporate Donation
Leo Madden Yusim Fund
The Jerry Maslowsky Memorial Fund
Contact Information
This is a*
Personal Donation
Company Donation
Company Name
Country*
(None Selected)
Australia
Bahamas
Canada
Israel
Korea, Democratic People's Republic Of
New Zealand
Pitcairn
Trinidad And Tobago
United States
Zambia
State / Province*
Address*
City*
State / Province*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
My Phone Number is
(None Selected)
My mobile number
My office number
My home number
My Email Address is
(None Selected)
My personal email address
My office email address
Is this Gift in honour or in Memory of Someone?
Yes or No?
(None Selected)
Yes
No
(None Selected)
in honor of
in memory of
Who is your donation in honour/memory of?
Should we Send a Card/Email on your Behalf?
Yes, please send a card
Yes, please send an email
No thank you
Email Address of Person to Notify
Address of Person to Notify
City of Person to Notify
Province of Person to Notify
Postal Code of Person to Notify
Who would you like your email/card to be from?
Donation amounts are listed in Canadian Funds.
Payment Information
Amount*
$
Payment Type
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