Please print this form and mail it with your cheque or fax it with a credit card number to:
Jean Pierre Laurin
Assistant Executive Director
Canadian Cancer Society
5151 de l'Assomption Boulevard
Montreal, Quebec H1T 4A9
Tel.: 514-255-5151, ext. 3200
Fax: 514-255-2808
jplaurin@quebec.cancer.ca
www.cancer.ca
To download this form, you will need Adobe Acrobat Reader. Please click on the 
to begin downloading the free software if it is not already installed on your computer.
