In Memory Donation Form - Cedars Cancer Foundation

Together we stand
for cancer patients

In Memory Donation

My Gift is in Memory of:

Memorial

If the name doesn’t appear in the list above, please complete the fields below.

In Memory of First Name:

In Memory of Last Name:

Please notify someone of this gift

Send an eCard

Send a mail card

No Card

Send a card through the mail

Deceased's Family - Person to Notify

Salutation:

First/Last Name:

Address:

Apt/Suite:

City:

Province/State:

Postal/ZIP Code:

Country:

Message to Family:

Send an eCard

Yes, Send an eCard Yes, I would like to send an eCard.

Select an eCard:

Email addresses for the deceased's Family - Person to Notify (seperate by commas):

Send eCard on:Select month of credit card Select Expiration Year

eCard Subject:

eCard Message:

Yes, send me a copy of the eCard.

Field Is Required Select gift amount:

$25.00

$25

$50.00

$50

$100.00

$100

$250.00

$250

Other

Enter amount

Note: A tax receipt will be issued, to the payer, for all donations of $18 or more.

Field Is Required Please direct my gift to:

Use my gift where it is needed most.

Direct my gift to:

Individual or Corporate Gift

Corporate Gift:

Make this gift on behalf of a corporation or a foundation

Corporation Name:

Contact First Name:

Contact Last Name:

Thank you contact

The person to thank is different than the contact person above.

Salutation:

First Name:

Last Name:

Title:

Email:

Donor Information

Salutation:

First Name:

Last Name:

Address:

Apt/Suite:

City:

Province/State:

Postal/ZIP code:

Country:

Email Address:

Phone Number:

Email opt in I would like to receive email updates from The Cedars Cancer Foundation.

Additional Amount:

$2.00 Yes, I'd like to offset processing costs so more of my gift can benefit The Cedars Cancer Foundation. $2.00 will be added to your donation total.

Cardholder Information

Please make sure your billing address is exactly as it appears on your credit card statement.

Billing information is the same as donor information

Salutation:

First Name:

Last Name:

Address:

Apt/Suite:

City:

Province/State:

Postal/ZIP Code:

Country:

Credit Card Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Together we stand for cancer patients