Ontario Horticultural Association DONATION REQUEST FORMDONOR INFORMATIONMy donation is*Please select one: Personal Company In Memoriam Name* First Last Email Address (for tax receipt purposes)* Company Name Company Website Mailing Address (for tax receipt purposes)* Street Address Address Line 2 City Postal Code Mailing Address*Please provide your mailing address so we can send you a tax receipt. Street Address Address Line 2 City Postal Code 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) 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 No. (if applicable) If 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 & PAYMENTRecurring DonationPlease set up this donation as a single or recurring amount as indicated: single monthly yearly I would like to pay by* E-Transfer to: treasurer4OHA@gmail.com 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 email@example.com 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 Marian Heil, 56 Glen Cannon Drive, Stoney Creek, ON L8G 4E1 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 Postal Code Donation Amount*Please choose your donation amount $25 $50 $100 $250 Other Amount Other Donation Amount: Total Donation $ 0.00 CAD 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 & Acknowledgment*Please 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 Email CommentsThis field is for validation purposes and should be left unchanged.