Form Step 1 of 2 (Information) Please check off one of the applicable boxes Yes, I want to support Pier 21 and receive your newsletter I would like my donation to remain anonymous Donor’s Information Title - None -Mr.M.Dr.Ms.Mrs.Mme Full Name Address City Province or State Country Postal Code Email Home Phone Do you have a connection to Pier 21? Yes No If yes, please specify your connection to Pier 21 / Other Gateway - None -ImmigrantVeteranRefugee / Displaced PersonWar BrideHome ChildGuest ChildWar Bride ChildPier 21 Staff / Volunteer Donation is in Honour of Donation is in Memory of Please send a card to someone, letting them know about the gift made in their honour (if yes, allow 4 weeks for delivery) Yes No Occasion Personal Message and From Whom Mail Card - None -To meDirectly to recipient Recipient(s)’ Information Recipient(s)' Name Address City Province or State Postal Code For a donation of $20.00 or more, an income tax receipt will be mailed in three to four weeks. Proceed to payment options Leave this field blank