Families of
Spinal Muscular Atrophy
Canada
Make a Pledge for a Cure!

 
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Families of Spinal Muscular Atrophy Canada
P.O. Box 97
Rivers, Manitoba R0K 1X0 
(800) 866-0016
http://www.CureSMA.ca

 
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All donations are tax deductible - a receipt will be issued.  To make a pledge to Families of SMA Canada, fill out the form below and click the "Send my Pledge!" button. You'll receive e-mail confirmation of your pledge, and we'll bill you for the amount indicated on the form.
 
This donation is (complete one if desired)
In Honor of:

In Memory of:

For Occasion:

If you would like a notice of your donation to be sent to another person, please include that person's name and address:

I wish to support Families of SMA Canada by making a contribution of:

Cdn $

Donor Information and Billing Address

Title:
First name:
Last name:
E-mail address:
Street address:
City:
State/Province:
Zip/Postal code:
Country:
Home phone:
Business phone:
Other information 
or special instructions:

Thank you very much for your pledge!
 (Please report any problems using this form to bettylou@curesma.ca.) 
 
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