Standing Together For a Cure Donation Form
(Please print form and mail to address below or click here)
Donations will be supporting both “Hope in Bloom” www.hopeinbloom.org & the
Please accept my donation in the amount of:
___$25 ___$50 ___$100 ___$250 ___$500 ___$1,000 ___$2,500 $ ________ Other
____ In lieu of cash, I would like to make a raffle donation, please contact me.
Donor Information:
Name* _______________________________________________________________________
Business or Organization (if applicable)* ____________________________________________
Address ______________________________________________________________________
City ______________________________ State ____________________ Zip ______________
Phone ____________________________ Email _____________________________________
*Please provide us with your name as you wish it to be published in our donor list in the Program on the day of our Four Bitchin’ Babes/Breast Cancer Fund Raiser on Sunday, November 8, 2009. If you are donating on behalf of a business or organization, we will acknowledge this as you indicate. Check the box below if you wish to remain anonymous.
Gift given: to honor _______________________ in memory of _______________________
Thank you for your donation to “Standing Together for a Cure” Breast Cancer Fund Raiser. Your gift is tax deductible to the extent allowed by law.
____ Please acknowledge my donation.
____ Please acknowledge my donation but not the dollar value.
____ I (or my organization) wish to remain anonymous.
Please make your check payable to “Standing for a Cure” and mail to:
Dale Gudejko,
http://standingtogetherforacure.webs.com/
Thank you for your support ~ Dale Gudejko, Anne Blackington & Kimm DelGizzi