Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Shoebox Fundraiser - Yes! I want to make a donation to help Shoebox sponsor a Hearing Dog Guide!YesPrénom de l'employé *Nom de famille de l'employé *Who's donating today? *Donating as an individualDonating on behalf of a corporation (no tax receipt provided)Donating on behalf of a Lions club (no tax receipt provided)Donation to (Please Enter Employee Full Name) Fundraising Campaign *What type of gift would you like to give? *One-TimeMonthlyChoose your gift amount *50OtherChoose your gift amount *$10/month$25/month$35/month$50/monthOtherCustom Amount *Company / Organization InformationEnter your company or Lions Club information below.Company / Organization Name *Company / Organization Address *AdresseVille--- Sélectionner : state ---Colombie-Britanniquel'Ontario QuébecAlbertaManitobaNouveau-BrunswickTerre-Neuve-et-LabradorNorthwest TerritoriesNouvelle-Écossele Nunavut Île-du-Prince-ÉdouardSaskatchewanle Yukon AlaskaAlabamaArkansasAmerican SamoaArizonaCalifornieColoradoConnecticutDistrict of ColumbiaDelawareFlorideGéorgieGuamHawaïIowaIdahoIllinoisIndianaKansasKentuckyLouisianeMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaCaroline du NordDakota du NordNebraskaNew HampshireNew JerseyNouveau-MexiqueNevadaNew YorkOhioOklahomaOregonPennsylvaniePuerto RicoRhode IslandCaroline du SudDakota du SudTennesseeTexasUtahVirginieVirgin IslandsVermontWashingtonWisconsinVirginie-OccidentaleWyomingProvince / ÉtatCode postal--- Sélectionner : country ---CanadaÉtats-Unis d'AmériqueCampagneYour InformationName *FirstLastEmail *Phone *CommentsBilling InformationAddress *AdresseVille--- Sélectionner : state ---Colombie-Britanniquel'Ontario QuébecAlbertaManitobaNouveau-BrunswickTerre-Neuve-et-LabradorNorthwest TerritoriesNouvelle-Écossele Nunavut Île-du-Prince-ÉdouardSaskatchewanle Yukon AlaskaAlabamaArkansasAmerican SamoaArizonaCalifornieColoradoConnecticutDistrict of ColumbiaDelawareFlorideGéorgieGuamHawaïIowaIdahoIllinoisIndianaKansasKentuckyLouisianeMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaCaroline du NordDakota du NordNebraskaNew HampshireNew JerseyNouveau-MexiqueNevadaNew YorkOhioOklahomaOregonPennsylvaniePuerto RicoRhode IslandCaroline du SudDakota du SudTennesseeTexasUtahVirginieVirgin IslandsVermontWashingtonWisconsinVirginie-OccidentaleWyomingProvince / ÉtatCode postal--- Sélectionner : country ---CanadaÉtats-Unis d'AmériqueCampagnePayment InformationCredit Card *E-CardSend an e-Card with this donationE-Card Recipient's Email *Choose E-Card Type *GeneralSympathyAnniversaryCongratulationsHappy BirthdayMother's DaySeason's GreetingsThank YouValentine's Day E-Card Preview E-Card Preview E-Card Preview E-Card Preview E-Card Preview E-Card Preview E-Card Preview E-Card Preview E-Card Preview Message to include in E-CardTotal Donation Amount$0.00Anonymous DonationMake this donation anonymousYour donation will remain anonymous and your name will not be printed in the annual reportSubmit Donation