Sign up to become a monthly donor. This gift is from:* Individual Company/ Group Donor InformationTitle:*select one...Mr.Mrs.Miss.Ms.Mr. and Mrs.Dr.OtherCompany/ Group name:* Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Phone*CampaignApply my donation to:*Wherever my gift will help mostRedevelopment CampaignMental Health redevelopmentOtherIf other, please specify:Donation DetailsPlease accept my monthly donation of: $25 $50 $100 Other To be deducted on the 15th of each month. Someone from our office will contact you to collect your credit card information.Amount* I wish my gift to remain anonymous* Yes No Lasting ContributionsI am interested in learning about giving through... My Will My Gifts of Securities My RRSP Additional InformationHow did I hear about RCH FoundationPlease Select One...EventFamily / FriendI work at RCHMailingNewspaperPatient VisitRadioRCH Foundation E-MailSocial MediaYour Health Matters NewsletterWord-of-mouthThank you for supporting Royal Columbian Hospital Foundation by becoming a monthly donor. You may increase, decrease, or cancel your monthly gift by contacting the RCH Foundation at 604.520.4438 or info@rchfoundation.com at least two business days prior to your next scheduled payment.A portion of all specified gifts is used to support the work of the RCH Foundation. A small fee is placed on each donation by the credit card processing company. No other fees apply to donations made on rchfoundation.com RCH Foundation is committed to protecting the privacy of all personal information that you share with us. We do not rent, sell or share our donor lists. The information we collect is used to process donations and keep you informed about the hospital and Foundation. Total Monthly Contribution: $ 0.00 CAD To be deducted on the 15th of each month. Someone from our office will contact you to collect your credit card information.I have remembered Royal Columbian Hospital Foundation in my Will Yes