Tribute Donation


If you would like to make an in honour / in memory donation as an individual and not a company gift use this form.


Thank you for choosing to support local individuals and families living with dementia.

Field Is Required Enter a Gift Amount:

Tribute Information

Who is this gift in honour of memory of?

Who is this tribute donation from?

Mail a Printed Card

Send an Electronic Card

Please note your personal message cannot exceed 255 characters.

Donor Billing Information

The name and address you enter below must match your credit card details in order to process this donation. The Canada Revenue Agency (CRA) does not permit us to issue tax receipts to anyone other than the donor (the person whose name is on the credit card).

Donor Payment Information

Credit Card Information:

Credit Card Type:
  • Visa
  • Diners Club
  • Discover
  • American Express
  • MasterCard
What is this?