BSDCC Donation Form

Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Donation for*

Belgian Shepherds in Need (rescue/rehome)National specialtyFMBB teamAny of the aboveOther
Type of payment

Credit cardPaypalE-transferCheque
Please select

prevnext( X )
CADDonation
Residents of Quebec: some Quebec based banks require a password to be set for e-transfers. In such case please use password "BSDCC" (without quotes, in capital letters).
For e-transfers, please send to: Treasurer@bsdcc.org
Please specify the name the donation is from on the cheque, and mail it to:

Donna-Marie Cyr
BSDCC Treasurer
705 Jacobson Drive
Williams Lake, BC
V2G 5M2
Should be Empty: