| To
Donate By Mail
Please Print
This Form and send it with a
check or your credit card information to:
Cancer research Foundation
P.O. Box 124
South Salem, N.Y. 10590
(Please do not send cash
in the mail.)
If your employer has a matching
gifts program, you may have an opportunity to
double your gift. Click HERE
to learn more.
About You:
Name: ________________________________
Company: _____________________________
Address: ______________________________
City: _________________ State:
___________ Zip Code: ________
Telephone: _______________
Enclosed is my donation of:
While we encourage donations
in the following amounts, we will gratefully
accept a gift of any size.
 $100
$300
$500
Other
$_______________
1. Enclosed is my check in the
amount of $ _________
2. Please charge my credit card in the amount
of $ __________
Visa
MasterCard
Card Number: ___________________
Expiration Date: ________
Thank you very much for your support.
Your gift will help us find cures for Kidney
Cancer, Breast Cancer, Leukemia, Lymphoma, Multiple
Myeloma and Mylodysplasia, and improve the quality
of life for patients and their families.
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