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Please print the form below, fill it out and mail it to us with your tax-deductible gift, made payable to PAACT, Inc., or your credit card information. All gifts are made in U.S. dollars.
Tribute gifts support the daily operations of PAACT, Inc., by furnishing PC patients and advocates with the latest information available on the methods of detection, diagnostic procedures, evaluation and treatments for prostate cancer.
Yes! I/we wish to support PAACT, Inc. (Patient Advocates for Advanced Cancer Treatment) Please send me PAACT’s Prostate Cancer Communication quarterly newsletter □ YES □ NO GIFT FROM: Name______________________________________ Address______________________________________ City_____________________________State_________________Zip_____________ Phone (________)_________________________________________
Enclosed is $_________________, a gift to the Lloyd J. Ney, Sr. Memorial Fund Enclosed is $_________________, for PAACT’s general operating expenses. Enclosed is $_________________, I/we wish to remain anonymous Enclosed is $_________________, In Honor of, or Birthday, Anniversary, etc. __________________ Enclosed is $_________________, In Memory of__________________________________________ Please send acknowledgement card to: Name__________________________________________________ Address_________________________________________________ City_____________________________State________________Zip_______________
□ Check Enclosed (Please make your check payable to PAACT, Inc.) □ Please charge to my credit card (below): □ MC □ VISA □ Discover □ American Express Name of card holder_____________________________ Signature________________________________ Card Number_____________________________________________________ Expiration Date________________________Amount $___________________
Do you or your spouse’s employer have a matching gift program? If so, please enclose employer’s form. You can also donate through participating charitable organizations such as United Way, Etc.
The completed form should be mailed to:
PAACT INC. “PATIENT ADVOCATES FOR ADVANCED CANCER TREATMENTS” P.O. Box 141695 Grand Rapids, MI 49514
Or
PAACT INC. “PATIENT ADVOCATES FOR ADVANCEDCANCER TREATMENTS” 1143 Parmelee Ave NW Grand Rapids, MI 49504 |
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“Let’s Conquer Prostate Cancer In OUR Lifetime” |
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PAACT Inc. (Patient Advocates for Advanced Cancer Treatments) PO Box 141695 Grand Rapids, MI 49514
1143 Parmelee Ave NW Grand Rapids, MI 49504 |
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To contact us: |
