Thank you for supporting The Study and its students. Any information entered on this form is confidential and secure.
Donor Information
* = required
Full Name *
Affiliation *
Class of     (4 digits, if applicable)
Address Line 1 *
Address Line 2  
City *
Province/State *
Postal/Zip Code *
Daytime Telephone *
Email *
All donors will be acknowledged in our Annual Report. Our fiscal year runs from July 1st to June 30th. If you do not wish to be included, please check the box below
  I would like to remain anonymous
Gift Information
I am proud to support The Study's 2016-2017 Annual Giving Campaign:
One-time gift of $
A monthly recurring gift, charged to my credit card, in the amount of $
Directed Donations
* I would like to support:
Head's Initiatives
Direct-funded Support of Bursaries & Scholarships
Facilities Enhancements
The Study's General Endowment Fund
Other (Please Specify)
Payment Information
  Please keep my credit card details on file for any installment payments
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Expiration Date *   *
Name on Card *
Matching Gifts
Please indicate whether your employer and/or your spouse's employer will match your gift.
  Yours | Spouse | Organization Name(s)
Yes, matching form will be sent later
Please fax your form to Belinda Hummel at (514) 935-1721 or mail to:
The Study, 3233 The Boulevard, Westmount, Quebec, H3Y 1S4

The Study's Tribute Program (available for gifts of $50 or more)
If your gift is in honour of someone, please specify the occasion (i.e. birthday, retirement, graduation, etc.)

I would like this gift to be in Honour / Memory of:
      In Honour   In Memory
  I would like to send a notification of my gift to:
Mailing Address
Special Instructions
Please let us know if you would like us to contact you about making a gift of securities, donating life insurance, or organizing a planned gift. Please contact Advancement at 514-935-9352 ext 224.

Thank you for your support! An official charitable tax receipt will be mailed to the above address.
Charities Registration # BN 10525 2845 RR0001


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