YES! I would like to help Diane reach her goal of raising $4,000 for
the Leukemia and Lymphoma Society!
|
$26.20 |
Aloha Donation ($2/mile) |
|
$52.40 |
Hula Donation ($4/mile) |
|
$100.00 |
Luau Donation (a nice round number…) |
|
$500.00 |
Paradise Donation (never
hurts to suggest it J…) |
|
$_______ |
You choose the amount!
Every contribution makes a difference. |
Please complete the information
below, and return this form with your tax deductible donation, payable by any of the three methods noted below.
Name:_____________________________________________________________________
Address:
___________________________________________________________________
City, State, Zip:
______________________________________________________________
E-mail
(for my email training updates): ____________________________________________
Donation by Check
Make check payable to
The Leukemia & Lymphoma Society.
Donation by Credit Card
If you would like to pay
with American Express, Visa or MasterCard please complete the following:
Credit Card Type: American Express ( ), Visa ( ), or MasterCard ( ) [check one].
Credit
Card Number ____________________________________ Expiration Date ________
Name
as it appears on the card ________________________________________________
Online Donation
You can also donate on
line by visiting http://www.active.com/donate/tntsvmb/tntsvmbDGullin
I would like to add the names of my contributor’s family members
who have been diagnosed with a blood related cancer to my list of honorees in whose honor I train and fundraise. I include
their name on my running jersey for my race. If you have a family member or friend
that I could train in honor of please let me know their name:_____________________________________________________.
THANK YOU VERY MUCH FOR YOUR SUPPORT!Enter supporting content here
