It Takes You Pledge Form

It takes you.

JOHN STODDARD CANCER CENTER COMPREHENSIVE CAMPAIGN

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: