MHAuxiliary Donation Form

I wish to make a donation to the MHAuxiliary of the Carleton Place and District Memorial Hospital. You will find enclosed either a cheque in the amount of: or please charge the amount of: to my credit card as follows:
Credit Card:	MasterCard American Express Visa
Credit Card Number:
Credit Card Expiry Date:
First Name:
Last Name:
Signature:
Date:
Complete Mailing Address:
Please return to: MHAuxiliary Carleton Place & District Memorial Hospital 211 Lake Ave E. Carleton Place, ON K7C 1J4 or Fax (613) 257-3026 *An income tax receipt will be issued.*

News + Events

All site materials Copyright (c) carletonplacehospital.ca
Technology and Hosting by Tomahawk Technologies Inc.