You can donate on line with:

OR you can forward your donation to:

HERSTREET FOUNDATION
1100 René-Lévesque Blvd. W.,
25th floor, Montreal, Quebec
H3B 5C9

Telephone: (514) 840-2681

ALL DONATIONS OF $200 OR MORE WILL BE REGISTERED IN OUR DONOR BOOK.

Please indicate whether you wish your name to appear in this book: ___ YES ___ NO

I would like to make a donation of

50 $	75 $	100 $	250 $	500 $
OTHER ________________

TYPE OF PAYMENT:
CHEQUE - made out to Herstreet Foundation/Fondation La rue des Femmes
CREDIT CARD
Type of card: __ Visa __ MasterCard
Card number: ___________________
Signature: __________________________
Expiry date: _____________________

MONTHLY CONTRIBUTION
SERIES OF POST-DATED CHEQUES; You will find enclosed ________________ cheques,
for a total contribution of $______________________.

MONTHLY CREDIT CARD DEDUCTION: ____________
Start of the contribution ___/___/___
End of the contribution ___/___/___

Form of address: __ Mrs. __ Ms. __ Mr.
First and last name: ______________________________________
Address: ____________________________________________
City: _______________________________________________
Province: _______________ Postal code: _________________
Telephone number: _________________________________

Would you like to receive a tax receipt: ___ YES ___ NO

Our federal registration number is: 86188 7214 RR0001