Online Payroll Deduction Form

To donate via payroll deduction, please complete the online form below.

To contribute via cheque or credit card please print the Employee Donation Form [.pdf] and fax it or mail it to us at:

The Best Care for Life Campaign
900 - 2155 Guy
Montréal (Québec) H3H 2R9
Fax: 514 931-5696

I am proud to give to The Best Care for Life Campaign through the foundation of my choice: *

Personal Information

Last Name: *

First Name: *

MUHC Employee Number: *

Site: *

Address (home): *

City: *

Province: *

Postal Code: *

Telephone (home): *

Telephone (work): *

Email: *

Preferred language:

Choosing your donation. Charitable donation will appear on your T4 slip

I would like the following amount to be deducted from each pay, based on 26 pay periods per year. :

Other amount: $

for a duration of:

Please select a commemorative gift for your annual donation

$10 x 26 or $260:

$5 x 26 or $130 :

$2 x 26 or $52:

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