Employee Giving Program
First Name *
Last Name *
Organization Name
Address
City *
Postal/Zip Code *
Country *
Canada
USA
Province/State *
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Phone
Email *
Organization
Amount
I authorize my employer to deduct this amount per pay period
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