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Please fill out the information below. Your donations are private
and secure.
Any contribution may be given as a Memorial/Honorarium. See information below.
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$50,000 |
Celestrial Angel |
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$20,000 |
Heavenly Angel |
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$10,000 |
Grand Benefactor |
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$5,000 |
Underwriter |
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$2,500 |
Patron |
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$1,000 |
Sponsor |
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$100 |
Pledge of $100 a year for ten years* |
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| All Guardian Angels are automatically enrolled as Charter Members. |
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$100 |
Charter (provides 2 free mammograms) |
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$50 |
Patron |
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$35 |
General |
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| I do not wish to become a member at this time, but I would like to
send a donation so that someone may receive the “gift of life.” |
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$10 |
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$25 |
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$50 |
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$100 |
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Other $ |
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I wish to be recognized as a breast cancer survivor. |
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I wish to be recognized as a prostate cancer survivor. |
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I wish to be recognized as a testicular cancer survivor. |
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I would like my gift to support BOTH the Breast and Prostate Health
Programs. |
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I would like my gift to support the Breast Health Program. |
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I would like my gift to support the Prostate Health Program. |
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| My membership contribution or special gift is: |
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| In memory of:
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| Your relationship to deceased:
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Or
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| In Honor of:
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Commemorating:
(Indicate birthday, anniversary, speedy recovery, or other special occasion.) |
| Your relationship to honoree:
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| Preference: |
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| *An individual or company pledging $100 for 10 years is designated
as a Guardian Angel only for the year in which the pledge is made. Thereafter,
the $100 annual payment goes toward the pledge and charter membership. |
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| *Required |
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