I Would Like to Make a Donation by Check

I want to help to find a cure for Hodgkin's Disease.

Here is my donation amount:
( ) $25 ( ) $50 ( ) $100 ( ) Other $________

This donation is:

____ A General Donation

____ In Memory of: ______________________________

____ In Honor of: _______________________________

Please indicate to whom you would like the acknowledgement letter sent:

Name:____________________

Address:___________________________________

City: _____________________________________

State: ____________________________________

Zip Code: _________________________________

Please enter your information below:

Name: ____________________________________________

Address: _________________________________________

City: ____________________________________________

State: ___________________________________________

Zip: _____________________________________________

Phone: ___________________________________________

Email: ___________________________________________

Please make your check payable to THE KDH HODGKIN'S DISEASE FOUNDATION, and mail it, along with this completed form, to:

The KDH Hodgkin's Disease Foundation
9 Lakeshore Blvd.
Massapequa, NY 11758

Your cancelled check will serve as proof for your tax records.

Thank you for joining us in the fight to find a cure for Hodgkin's Disease.