Donation ENG

Please complete the form below before making your donation. A tax receipt will be issued. Once the form is completed, you will be redirected to PayPal to complete the transaction.

First name*
[text* your-first-name]

Last name*
[text* your-last-name]

Email*
[email* your-email]

Phone number*
[tel* telephone]

Address*
[text* addresse]

City*
[text* ville]

Province*
[select* province « QC » « ON » « AB » « BC » « MB » « NB » « NL » « NT » « NS » « NU » « PE » « SK » « YT »]

Postal Code*
[text* code-postale 6/6 class:uppercase]

Message (optional)
[textarea your-message]

[checkbox mc-subscribe default:1  » Yes, I would like to subscribe to the CSUQ’s newsletter. »]

Please copy the code into the field below.

[captchac captcha-300] [captchar captcha-300]

[submit « Make a donation »]

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Thank you for your support !

Hessed – Donation de [your-first-name] [your-last-name]
[your-first-name] [your-last-name] <[your-email]>
De : [your-first-name] [your-last-name]<[your-email]>

Hessed – Donation de [your-first-name] [your-last-name]

Nom: [your-first-name] [your-last-name]
Courriel: [your-email]
Numéro de téléphone: [telephone]
Addresse: [addresse], [ville], [province], [code-postale]

Message:
[your-message]

Cet email a été envoyé via le formulaire de donations de Hessed (http://hessed.ca)
tbenlolo@csuq.org

[your-subject]
[your-name] <[your-email]>
Corps du message :
[your-message]


Cet email a été envoyé via le formulaire de contact de Shaare Hessed (http://hessed.ca)
[your-email]

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