Donation Form "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged. DONOR INFORMATIONMy donation is* Personal Company In Memoriam Name* First Last Company nameCompany websiteEmail address (for tax receipt purposes)* Mailing Address (for tax receipt purposes)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country DONATION INSTRUCTIONSThis donation is to be used to: Support grants, awards, convention, community initiatives, website, and the general operations of the association Donate to the OHA In-Memoriam Fund (supporting Tree Grants) Donate to the OHA Scholarship Fund Other Name of Deceased*Do you wish to have the deceased person's name recorded in the "OHA In Memoriam Book"?(a minimum, monetary donation of $25 per name required) Yes No Year Deceased (if known)Deceased's District number or town/cityIf you wish family to be notified of this donation:Please include their Name, Email or Mailing Address, and their relationship to the deceased.DONATION AMOUNT & PAYMENTI would like to pay by:* E-transfer Cheque Debit or Credit by PayPal Please complete the form using the Submit button at the end of the page and then send your e-transfer to *protected email* Please complete the form using the Submit button at the end of the page and then send your cheque (made payable to): Ontario Horticultural Association c/o OHA Treasurer, c/o Joy Cosmas Osiagwu, 1812 Haiku Street, Nepean ON, K2J 6W5Recurring DonationPlease set up this donation as a single or recurring amount as indicated: single monthly yearly Name for payment providerPlease list your full name as it appears on your credit/debit card. First Middle Last Address for payment providerPlease enter your address exactly as it appears on your last credit card statement. Payment verification will fail if this doesn’t match. Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Donation AmountPlease choose your donation amount $25 $50 $100 $250 Other amount Other Donation Amount Total Do you wish to have the deceased person's name acknowledged at our next convention?(no monetary donation required) Yes No DONOR AUTHORIZATIONS & SUBMIT FORMPermission & AcknowledgmentPlease indicate if you give the OHA permission to publish your name and/or company name on marketing materials, our website, on social media, in print, at our convention, or in the OHA newsletter. For company contributions, we would be happy to also add a link to your website from ours. Yes, I give you my permission to use my name as listed above No, I do not give you permission to use my name as listed above Subscribe to our Newsletter*Please indicate if you would like to receive notifications of upcoming events and our Trillium newsletter by email. Yes No Newsletter subscription email* Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
