Please Print This Form and send it with a check 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. Or simple use PayPal.

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.