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Transaction
2
Personal information
3
Payment
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Donation after receiving treatment
Transaction
One-time gift
Monthly gift
Amount of my contribution
$25
$50
$100
Subtotal:
Total:
$
Total:
$
J'ai reçu une lettre du CIUSSS de l'Estrie-CHUS.
Yes
No
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Organization's registration number:
119000529-RR0001
Time remaining in your session:
20
Time remaining in your session:
20