Be a Hero - Southlake Regional Health Centre Foundation

Please enter your donation in support of Ian Laing in the 2023 YRP Be a Hero Head Shave!

Field Is Required Select Gift Amount:

$500.00

$100.00

$50.00

$25.00

Choose your own Amount

Enter amount

Make this gift on behalf of an organization

Organization Name:

Title:

First Name:

Last Name:

Address:

City:

Province:

Postal code:

Country:

Phone Number:

Email Address:

Yes, I'd like to receive occasional email updates from Southlake Regional Health Centre Foundation.

Yes, I would like to make this donation anonymously.

Hideme

I am part of the Southlake Family.

Hideme

Donor Employer:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Billing information is the same as Donor information.

Title:

First Name:

Last Name:

Address:

City:

Province:

Postal Code:

Country:

Will info re leaving a gift

I would like more information about leaving a gift to Southlake Foundation in my will.

Will already left gift

I have already left a gift for Southlake in my will.