A Christmas To Cure Cancer Donation Form
Directions
:
Print this order form.
Provide the address you wish to have your free gifts mailed to.
Calculate your order, including Shipping & Handling using the table below.
Choose your donation.
Choose your charity.
If paying by check, make
checks
payable to "
A Christmas To Cure Cancer
".
Mail your order to:
A Christmas To Cure Cancer
7952 Thornbush Dr
Westerville, OH 43082
Name:
____________________________________________________________
Address 1:
____________________________________________________________
Address 2:
____________________________________________________________
City:
__________________________
State:
______
Zip:
_____________
Phone:
__________________________
E-Mail:
__________________________
Item Description
Donation
Quantity
Total
Please send me a "A Christmas To Cure Cancer 6 Double CD" as a free gift for my donation of $20.
$20.00
Please send me a "A Christmas To Cure Cancer 5" as a free gift for my donation of $15.
$15.00
Please send me a "Buckeye Cruise for Cancer" CD as a free gift for my donation of $20.
$20.00
Please send me a "Blues Cures Studio Jam" CD as a free gift for my donation of $15.
$15.00
Please send me a "Hot Pink Racers - Live For A Cure" CD as a free gift for my donation of $9.99.
$9.99
Combination Heather Pick CDs, "Circle of Support" & "A Christmas To Cure Cancer 3" with "Santa Baby"
$25.00
Please send me "A Christmas To Cure Cancer 4" as a free gift for my donation of $15.
$15.00
Please send me Sean Carney's CD, "Blues For A Cure" as a free gift for my donation of $15.
$15.00
Please send meSean Carney's CD, "Blues For A Cure Christmas" as a free gift for my donation of $15.
$15.00
Please send me Heather Pick's CD, "Circle of Support" as a free gift for my donation of $15.
$15.00
Please send me Kelly Delaveris' CD, "My Christmas Gift" as a free gift for my donation of $15.
$15.00
Please send me Kelly Delaveris' CD, "My Gift " as a free gift for my donation of $15
$15.00
Please send me "A Christmas To Cure Cancer 3 " as a free gift for my donation of $15
$15.00
Please send me "A Christmas To Cure Cancer 2" as a free gift for my donation of $15
$15.00
Please send me "A Christmas To Cure Cancer" as a free gift for my donation of $15
$15.00
Please send me a "A Christmas To Cure Cancer" blue wristband as a free gift for my donation of $2
$2.00
Please send me a "Heather Pick Circle of Support wristband" as a free gift for my donation of $2
$2.00
Please send me a white "A Christmas To Cure Cancer T-Shirt" as a free gift for my donation of $20
Medium
Large
X-Large
XX-Large
$20.00
Please send me a Men's Red "A Christmas To Cure Cancer" Embroidered Dress Shirt as a free gift for my donation of $35
Medium
Large
X-Large
XX-Large
$35.00
Please send me "A Coins To Cure Cancer Piggy Bank" as a free gift for my donation of $15
$15.00
Charitable Donation
Shipping Charges, Number of Items and Cost:
CD's
1
for
$3.00
2
for
$4.00
3
for
$5.00
4
for
$6.00
5
for
$7.00
Shirts
1
for
$3.00
2
for
$5.00
3
for
$7.00
4
for
$9.00
5
for
$11.00
Vidoes
1
for
$3.00
2
for
$5.00
3
for
$7.00
4
for
$9.00
5
for
$11.00
Piggy Banks
1
for
$3.00
2
for
$5.00
3
for
$7.00
4
for
$9.00
5
for
$11.00
*More than 5 items of any category
, contact us at (614) 906-4700 or
orders@achristmastocurecancer.org
for Shipping prices.
Shipping & Handling:
$ ______________
Grand Total:
$ ______________
Choose a Charity:
A Christmas To Cure Cancer
To help us cover costs of CD duplication, every $1 brings $15 in benefit towards cancer research.
Nationwide Children's Hospital Pediatric Cancer Research, Columbus, OH
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research
- Columbus, OH
Cancer Research and Prevention Foundation - Alexandria, VA
The Tressel Family Fund for Cancer Prevention Research
Duke Comprehensive Cancer Center - Durham, NC
Stefanie Spielman Fund For Breast Cancer Research
The Burnham Institute - La Jolla, CA
American Cancer Society - Ohio Division
University of Colorado Cancer Center - Aurora, CO
Ohio Cancer Research Associates - Columbus, OH
University of Iowa Holden Comprehensive Cancer Center - Iowa City, IA
The Heather Pick Spirit Fund - Benefiting The Columbus Cancer Clinic, Columbus, OH
Thank you for your donation!