To make a donation**, please print, fill out and mail the donation form along with your cheque to MAP at the following address:

Medical Aid for Palestine
5722 St-André
Montréal, Québec, Canada
H2S 2K1

MAP thanks you!

Name: ________________________________________________________

Address: ______________________________________________________

City/Prov. : ____________________________________________________

Postale Code: _________________

Telephone: (____)__________________Fax: (____)__________________

Email : _______________________

Amount: _______________

___ cheque

___ Visa #: _______________________________________

Exp.: _______________

Signature : ____________________________ Date : ____________________