I would like to help the Foundation promote and ensure quality cancer care for women by becoming a
contributor
Please print out this page, complete and mail with your check or money order made payable to the Foundation
for Women’s Cancer, or fax with credit card information to:
Foundation for Women’s Cancer
230 W. Monroe, Suite 2528
Chicago, Illinois 60606
Phone 312-578-1439 Fax 312-578-9769
To donate online, log on to www.foundationforwomenscancer.org, and click on the Donate Now link

Contributor information
Name __________________________________________________________________________________
Address _________________________________________________________________________________
City, State, Zip ___________________________________________________________________________
Daytime phone ___________________________ eMail___________________________________________
□ Enclosed is my tax deductible contribution of $_________________
□ The enclosed contribution is In Memory of ____________________________________________________
□ The enclosed contribution is In Celebration/Honor of ____________________________________________

Please send an acknowledgment letter to
Name __________________________________________________________________________________
Address_________________________________________________________________________________
City, State, Zip ___________________________________________________________________________
 Credit Card Donation

□ Please charge my credit card $ _____________ Circle one: Visa MasterCard American Express Discover
________________________________________________________________________________________
Card number
Expiration Date
Security Code
____________________________________________________________________________
Signature
Today’s Date
□ Please put me on your list to receive information about upcoming Patient Education Courses
□ I would like more information on how to include the Foundation in my will. Please contact me
□ I would like to make a gift of stock. Please contact me
For more information about the Foundation, log on to www.foundationforwomenscancer.org.
Thank you for your support!