It takes
you.
J O H N STO D DA R D C A N C E R C E N T E R C O M P R E H E N S I V E C A M PA I G N
Please accept this pledge of $_________________________to be paid over: one year two years three years four years five years starting______________, ____________ Month
Year
I’d like to designate my gift to the following program area: ____________________________ Area to be named, if applicable: ___________________________________________________ Payments will be made:
Annually
Other _________
Name/Business: _________________________________________________________________ Address: _____________________________________ Phone: ___________________________ City: _________________________________ State: ______________ Zip: __________________ Email address: ___________________________________________________________________ Donor Name(s): _________________________________________________________________ (Please print as you would like to be listed for Donor Wall and/or publications)
I do not wish to have my name listed.
This gift is:
In memory of: ____________________________________________________________
In honor of: ______________________________________________________________
Signature: __________________________ Date:_______________________________________
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