Donate Online

I would like to donate:	US$
Option 1:	Option 2:
Monthly donation	Single donation
You can change your monthly contribution at any time by contacting the WFH at wfh@wfh.org

In Memory / In Honour
If you would like to make your donation in memory of or to honour someone, please fill in the name of the individual and check one of the boxes below.

In memory
In honour
name of individual

For United States Donors:
I would like to direct my donation to the World Federation
of Hemophilia USA, allowing me an IRS tax deduction.

For Canadian Donors:
I would like to receive a charitable tax receipt.

If paying by money order or by cheque (drawn on a U.S. bank or an affiliate), print a copy of this form and mail the completed form to:
1425 René Lévesque Boulevard West, Suite 1010, Montréal, Québec H3G 1T7 Canada.

You can also download the donation forms in PDF format.
WFH donation form (PDF)
WFH USA donation form (PDF)

Title :	*
First Name:	*
Last Name:	*
Organization:
Address: Home Work	*
City:	*
State/Province:	*
Country:	*
Zip/postal code:	*
Phone number (with country, city, area codes):
Fax number (with country, city, area codes):
Email Address:	*

Preferred language of communication:

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Thank you for your generosity!

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@ World Federation Of Hemophilia 2008