Ontario Horticultural Association DONATION REQUEST FORMDONOR INFORMATIONMy donation is*Please select one:PersonalCompany donationIn MemoriamName* First Last Please provide your email address* Company NameCompany Website Mailing AddressPlease provide your mailing address so we can send you a tax receipt. Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code DONATION INSTRUCTIONSThis donation is to be used toSupport grants, awards, convention, community initiatives, website, and the general operations of the associationDonate to the OHA In-Memoriam Fund (supporting Tree Grants)Do you wish to have the deceased person's name acknowledged at our next convention?YesNoIn Memory ofPlease list the deceased's full name as you would like it to be acknowledged during our convention. Leave blank if you would like it to be anonymous.Deceased's district numberPlease list the district number, if knownIf you wish family to be notified of this donation:Please include their Full Name, Email or Mailing Address, and their relationship to the deceased.DONATION AMOUNT & PAYMENTI would like to pay by*Debit or Credit by PaypalE-TransferChequePlease complete the form using the Submit button at the end of the page and then send your e-transfer to firstname.lastname@example.org 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 Jane Leonard, 17 Greystone Cres., Georgetown, ON L7G 1G8 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 Recurring DonationPlease set up this donation as a single or recurring amount as indicated:singlemonthlyyearlyDonation Amount*Please choose your donation amount$25$50$100$250Other AmountOther Donation Amount: Total Donation $ 0.00 CAD 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 aboveNo, I do not give you permission to use my name as listed aboveSubscribe to our Newsletter*Please indicate if you would like to receive notifications of upcoming events and our Trillium newsletter by email.YesNoEmailThis field is for validation purposes and should be left unchanged.