EyesOnThePrize.Org Mail-in Donation Form

To make a contribution to EyesOnThePrize.Org (a nonprofit organization), send a check or money order made out to "EyesOnThePrize.Org" to (online credit card donations may be made via PayPal):

EyesOnThePrize.Org
865 Sapphire Lane
Anaheim CA 92807

Please print this page and fill out the following information so that we may properly acknowledge your gift.

Your name _______________________________________________________

Street address _______________________________________________________

City, State/Province, Postal Code _______________________________________________________

E-mail address: _______________________________________________________

Amount of gift: $30 $60 $120 Other $ _______

Please acknowledge my gift on the Donors page on the EOTP web site: Yes No

Optional: This gift is in honor or memory of:

Name of survivor or deceased _______________________________________________________

Occasion (survivor anniversary, death, etc.) _______________________________________

Type of Cancer: _______________________________________

Mailing or e-mail address for acknowledgment note (if other than above):

_______________________________________________________

_______________________________________________________

If you would like your deceased loved one to be listed on our memorial page, please provide the following additional information:

Birth Date and Death Date _______________________________________________________

City, State/Province, Country _______________________________________________________

Tribute line: _______________________________________________________

E-mail contact for condolences: _______________________________________________________

 

The US Internal Revenue Service has granted EyesOnThePrize.Org 501 C3 tax-exempt status. Gifts to EyesOnThePrize.Org are tax-exempt in the USA to the full extent of the law. We will soon begin our incorporation and tax exemption process in Canada.

For more information, contact our Treasurer.

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