Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Shoebox Fundraiser - Yes! I want to make a donation to help Shoebox sponsor a Hearing Dog Guide!YesEmployee First Name: *Employee Last Name: *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 *Address Line 1City--- Select state ---British ColumbiaOntarioQuebecAlbertaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutPrince Edward IslandSaskatchewanYukonAlaskaAlabamaArkansasAmerican SamoaArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVirgin IslandsVermontWashingtonWisconsinWest VirginiaWyomingProvince / StatePostal Code / Zip Code--- Select country ---CanadaUnited States of AmericaCountryYour InformationName *FirstLastEmail *Phone *CommentsBilling InformationAddress *Address Line 1City--- Select state ---British ColumbiaOntarioQuebecAlbertaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutPrince Edward IslandSaskatchewanYukonAlaskaAlabamaArkansasAmerican SamoaArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVirgin IslandsVermontWashingtonWisconsinWest VirginiaWyomingProvince / StatePostal Code / Zip Code--- Select country ---CanadaUnited States of AmericaCountryPayment 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