Yes! Count me as a supporter.

I would like to make a gift to:

  • OMSBF

    (a program of the OMF) Designated funds for Ontario Medical Students in financial distress

  • OMF

    Undesignated funds in support of: Students. Physicians. Community.

  • Both

    OMSBF and OMF



Ontario Medical Student Bursary Fund

  • $3000 (equivalent to one bursary)
  • $2000
  • $1000
  • $500
  • $250
  • $100
  • Other Amount

(optional) I wish to designate my OMSBF donation to:

Ontario Medical Foundation

  • $3000
  • $2000
  • $1000
  • $500
  • $250
  • $100
  • Other Amount

Ontario Medical Student Bursary Fund

  • $3000
  • $2000
  • $1000
  • $500
  • $250
  • $100
  • Other Amount

(optional) I wish to designate my OMSBF donation to:

Ontario Medical Foundation

  • $3000
  • $2000
  • $1000
  • $500
  • $250
  • $100
  • Other Amount

I wish to donate anonymously

Yes
No

Please send my tax receipt* to:

  • Title:
  • First Name:
  • Last Name:
  • OMA Number:
  • Mailing Address:
  • City:
  • Province:
  • Postal Code:
  • Phone Number:
  • Email Address

Comments:



Payment

  • Total Due: $
  • Payment Method:
    Visa: Mastercard:

  • Credit Card Number:
  • Expiry Date: Month Year
  • Card Holder Name: