Alberta and NWT

Online Donate Form

You are using a secure connection! Breathe easy knowing that The Lung Association of Alberta & NWT's websites are safe.

If you prefer to donate by phone, call our toll free line at 1-888-566-5864

The Alberta Lung Association is committed to giving the 1 in 5 Albertans affected by a lung or breathing condition hope, help and a voice.

It is the generosity of donors like you that enables the Alberta Lung Association to provide lung patients with the support and encouragement they need. Thank you.

Contribution Amount

$ 25.00

$ 50.00

$ 100.00

$ 250.00

$ 500.00

$ 1000.00

Other Amount

Other Amount $

I want to contribute this amount every month

Your recurring contribution will be processed automatically. You will receive an email receipt for each recurring contribution.

Email Address *

I am contributing on behalf of an organization.

Organization Details

Organization Name *

Phone (Main) *

Email (Main) *

Street Address *

City *

Postal Code *

Country *

State/Province *

In Memory or In Honour of Donation

In Honor of In Memory of

Select an option to reveal honoree information fields.

Please fill out these extra fields for your "In Memory" or "In Honor" of Donation.

If you'd like a personalized acknowledgement sent please fill out the corresponding box below.

Individual Prefix

First Name *

Last Name *

Email Address

Send Acknowledgement Card

Acknowledgement Recipient

If you would like us to send a personalized acknowledgement card that a gift has been made, please fill in the name and full postal address of the recipient in the above box.

Personal Note

You may provide here a personal note to include in the acknowledgement card.

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Name and Address

First Name *

Last Name *

Street Address

City

Postal Code

Country

Province