PARC DONATION FORM


DEAR RSD FRIENDS,

 

PARC RSD SURVEY: “2 out of 3 see 3 or more doctors before a diagnosis.”

“Only 40% are diagnosed early (0-3 mo.) when the success rate is highest.”

This statistic comes from our RSD CANADA Survey .Every doctor and health care professional must be aware of CRPS, how to recognize, diagnose and treat it. This is not happening yet. Since May 2005, PARC has been conducting public CRPS Information Nights. We plan more in 2008. Thank you for your support!
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**FREE POCKET CARD WITH NEW MEMBERSHIP***

PARC MEMBERSHIP : NEW _____ RENEWAL _____ Last year: $_____

OPTION 1: DELUXE $35 (6 services)_____ OPTION 2: NEWSLETTER ONLY $25_____
PLEASE PRINT:

NAME: ______________________________ ADDRESS: ________________________________________________________________________


CITY/PROV: _____________________________________P CODE :________TEL./E-MAIL: _____________________________________________


Please make cheque payable to PARC, PO Box 21026, St. Catharines, Ontario, Canada L2M 7X2.


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POCKET CARD/DONATION FORM

“About 66% see three or more doctors before a diagnosis.”

Each doctor and health care professional must become aware of CRPS, how to recognize, diagnose and treat it. Early diagnosis is critical and often missed. With your help, PARC can educate professionals through education programs. PARC supports research into better treatments and a cure for CRPS. Proceeds will go towards PARC education and research at McGill University, Montreal. Please donate what you can towards our goals. Every dollar counts!
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WAYS TO HELP: I wish to make a donation to PARC.

$1,000____$500 _____$250_____ $100 _____ $50 _____ $25 _____ other _____ (Tax receipt will be issued.)

POCKET CARDS: I wish to receive _________ PARC POCKET CARDS. (Cards are $2 each.)
PRINT CLEARLY PLEASE. Please send tax receipt to:


NAME:________________________________ ADDRESS:_______________________________________________________________________


CITY/PROV:______________________________________P CODE:_________TEL/E-MAIL:______________________________________________


Please make cheque payable to PARC, PO Box 21026, St. Catharines, Ontario, Canada L2M 7X2. Tax receipts issued for donations $10 and over.

 

 

 

INFORMATION: PLEASE PRINT CLEARLY. THANK YOU!
NAME:  
ADDRESS:  
CITY/PROV/STATE:  

COUNTRY/ POSTAL

/ZIP CODE:

 
TEL/E-MAIL::  

I have enclosed a cheque

payable to parc:

 

yES ______NO ______

AMOUNT $________

 




 

 

 

 

 

 

 



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