CONVERSATIONS Contribution
Form
Please print this form and mail it to the address below.
Your Name
_____________________________________________________________
Address
_____________________________________________________________
City/State/Zip _____________________________________________________________
Telephone (home/work) _____________________(fax)
Enclosed is my UNRESTRICTED gift of $______________
in honor of
or in memory of
Enclosed is my RESTRICTED gift of $_____________
for the use of The Conversations Fund for Ovarian Cancer Research ONLY
in honor of
or in memory of
Please send an acknowledgment to: Name _______________________________________
Address _____________________________________
City/State/Zip _________________________________
Please make checks payable to:
CONVERSATIONS!
P.O.
Box 7948
Amarillo,
TX 79114-7948 USA
Phone:
(806) 355-2565 Fax: (806) 467-9757
Donation by Credit Card (please circle one):
Visa MC AMEX
Card Number:___________________________________Expire Date:_____________
Name as it appears on the card:___________________________________
Signature :___________________________________________________
CONVERSATIONS! The International Ovarian Cancer Connection
is a 501 (c)3 non-profit organization. Your gift is tax deductible to the fullest
extent of the law.(Ask your Financal Advisor about donations in the form of stock)
Please direct questions to the above address, to (806) 355-2565, or to contribution@ovarian-news.org
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