Entomological Society of Canada/ Société d’entomologie du Canada

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Donations - Secure Online Donation Form

Please mail cheques to:

The Entomological Society of Canada
503-386 Broadway
Winnipeg, MB
R3C 3R6

Campaign/Fund Information
Campaign/Fund *	Donation for Lloyd Dosdall Scholarship Fund/Dons aux fonds de bourse Lloyd Dosdall or Select a Different Fund

Donation Information
Donation Amount *	$
Payment Method *	Check/Money Order PayPal Credit Card
Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Province/State	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	(format: mm/yyyy)
Organization
Address *
Address Cont.
City/Town *
Country *
Province/State	(Reset)
Postal Code*
Billing Phone *

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