A Christmas To Cure Cancer Donation Form

Directions:
  1. Print this order form.
  2. Provide the address you wish to have your free gifts mailed to.
  3. Calculate your order, including Shipping & Handling using the table below.
  4. Choose your donation.
  5. Choose your charity.
  6. If paying by check, make checks payable to "A Christmas To Cure Cancer".
  7. Mail your order to:
    A Christmas To Cure Cancer
    5226 Columbine Ct.
    Columbus, OH 43230

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!