Contribution Form
I would like to make a tax-deductible gift to the American-Italian Cancer Foundation.
Gift Amount: $_______________
I would like my gift to support:
⇒ General purposes
⇒ Post-Doctoral Research Fellowships
⇒ Pancreatic Cancer Research Initiative
⇒ Mobile Mammography Program
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Name
____________________________________________________________________________________________
Address
_____________________________________________________________________________________________
City
State Zip
_____________________________________________________________________________________________
Telephone E-Mail
My gift is being made in honor/memory of:
______________________________________________________________________________________________
⇒ Check enclosed (Please make checks payable to the American-Italian Cancer Foundation)
Credit Card: ⇒ MasterCard ⇒ Visa ⇒ American Express
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Card
Number
Expiration Date
I would like to pledge my ongoing support to the American-Italian Cancer Foundation.
Please charge $__________ to my credit card:
⇒ Monthly ⇒ Quarterly ⇒ Annually
Gifts to the American-Italian Cancer Foundation
are tax deductible
to the extent permissible by law.
Tax ID #13-3035711.
