TEENS FOR A CURE Walk-a-thon Donation Form

							                               TEENS FOR A CURE
                            Walk-a-thon Donation Form
                 Yes! I want to support the American Cancer Society!
_____ Celebrate    $1-$99        Company Name: _________________________________________________
_____ Believe      $100          Contact Name: __________________________________________________
_____ Faith        $200          Street: _________________________________________________________
_____ Strength     $300          City: _______________________ State: __________ Zip: ______________
_____ Courage      $500          Phone: _________________________________________
_____ Inspire      $1,000        Email: _________________________________________
_____ Hope         $2,500        Donation receipt and tax ID number will be mailed to the address above.

_____ Other        $ ________


                                        Make Checks Payable to:
                                La Jolla High School ASB – Teens for a Cure

                                                Mail checks to:
                                          La Jolla High School – ASB
                                               Teens for a Cure
                                              750 Nautilus Street
                                          La Jolla, California 92037