Donation Form

A gift to Community Head Injury Resource Services (CHIRS) benefits many people with brain injuries. CHIRS will send a card on the donor's behalf to notify the person(s) that we have received a donation in their honour, or in memory of their loved one. This is a wonderful way to remember someone special, to honour someone close, to mark important occasions, to send condolences, and also to make a difference in someone's life. A charitable tax receipt will be sent to the donor. Please complete the form below and mail a printed copy to CHIRS' head office along with your cheque, or contact us.

I would like to make a donation to Community Head Injury Resource Services in honour/memory of

Optional personal message

A donation card will be sent to the person or family. If there is a particular member of the family to whom you wish the card to be addressed, please include the name here:


Please send the charitable tax receipt to:

Name:
Address:
City:
Province:
Postal Code:
Phone:	()
Amount:	$

Please make cheque payable to:
Community Head Injury Resource Services

Please forward to:
CHIRS
62 Finch Avenue West
Toronto, Ontario
M2N 7G1

Charitable Registration Number: 13121 9925 RR0001