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 : ____________________