Event Donation Form - National Brain Tumor Society
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1Event Donation Form
National Brain Tumor Society
EIN: 04-3068130
Please mail or fax this completed form to:
National Brain Tumor Society
[Event Name]
55 Chapel Street, Suite 200
Newton, MA 02458
Donations made with credit cards can also be faxed to 617.924.9998.
Please print clearly. Questions? Call 617.924.9997 or visit
DONOR INFORMATION
Name(s): ________________________________________________________________________________________________________________________________
Company (if applicable): _____________________________________________________ Title/Postion: ______________________________________________
Address: ________________________________________________________________________________________________________________________________
City: _______________________________________________________________________ State: __________________
Zip: ____________________________
Email: ______________________________________________________________________ Phone: ____________________________________________________
(Never sold or exchanged)
DONATION INFORMATION
F I/We wish to make a tax-deductible donation of $ _________________________
F I/We wish to make a monthly recurring gift of $_______________ ending on _____________.
Event Name: ________________________________________________________________
Team/Participant Name: _______________________________________________________________________________
Amount: $ ______________________
Team/Participant Name (if donating to more than one team): ______________________________________________
Amount: $ ______________________
Matching Gift:
Double your gift by submitting a matching gift form from your employer!
F My matching gift form is enclosed.
PAYMENT TYPE
F
F Check /money order enclosed, payable to National Brain Tumor Society.
F Charge my credit card $_______________
F
Circle one: Visa / Mastercard / American Express / Discover
Card #:
Exp. Date:
/
CVC #:
Billing Zip Code:
________________________________________________________________
Please print name as it appears on card
Signature of Cardholder
PRIVACY POLICY
National Brain Tumor Society values the trust you place in us. We will not sell, trade, or share the personal information you provide to us though
our website(s) or by participating in this event with anyone else, nor will we send donor mailings on behalf of another organization without your
written permission to do so. To read our complete privacy policy, visit /privacy.
Please sign below to acknowledge the Privacy Policy above.
Signature
Date
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