Donation Submission Form
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1
2Donation Submission Form
P.O. Box 1999, Memphis, TN 38101
Please complete and submit this entire form with all checks/money orders, made payable to St . Jude Children’ s Research Hospital
.
®
Return in the envelope provided . Please submit donations via check or money order only .
Total Donation Amount Enclosed:
Source Code:*
*Provide source code if label is not used below. Refer to Step 7.
# of Participants Turning in Money:
Date of Event:
Email:**
**Please ensure that your email address is accurate. This email address will be used to send your prize ordering instructions.
APPLY YOUR PROVIDED RETURN ADDRESS LABEL IN THE SECTION BELOW .
(Complete this section only if the label is not used.)
Event Town:
County:
State:
Coordinator:
Phone: (
)
Address:
City:
State:
ZIP:
IMPORTANT!
The information you provide on this form is needed for us to compile all of the data required
by our CPA and various regulatory agencies . Please sign and date below .
Coordinator’s Signature
Date
Donation Submission Form
P.O. Box 1999, Memphis, TN 38101
Please complete and submit this entire form with all checks/money orders, made payable to St . Jude Children’ s Research Hospital
®
.
Return in the envelope provided . Please submit donations via check or money order only .
Total Donation Amount Enclosed:
Source Code:*
*Provide source code if label is not used below. Refer to Step 7.
# of Participants Turning in Money:
Date of Event:
Email:**
**Please ensure that your email address is accurate. This email address will be used to send your prize ordering instructions.
APPLY YOUR PROVIDED RETURN ADDRESS LABEL IN THE SECTION BELOW .
(Complete this section only if the label is not used.)
Event Town:
County:
State:
Coordinator:
Phone: (
)
Address:
City:
State:
ZIP:
IMPORTANT!
The information you provide on this form is needed for us to compile all of the data required
by our CPA and various regulatory agencies . Please sign and date below .
Coordinator’s Signature
Date
1-800-567-0636
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7
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