Print and complete this form and mail with your donation to:
ALLIANCE FOR CANCER GENE THERAPY
Ninety-six Cummings Point Road
Stamford, CT 06902
Name ___________________________________________________
Telephone _______________________________________________
Street ___________________________________________________
City _____________________________________________________
State ________________________ Zip _____________________
E-mail Address ____________________________________________
I WANT TO HELP ADVANCE CANCER GENE THERAPY RESEARCH THROUGH A GIFT OF:
____ $5,000 ____ $2,500
____ $1,000 ____$500
Other amount $ _________________
____ My check is enclosed.
Enclosed is my employer's matching gift form.
I am interested in information about:
____ Named Grant
____ Endowment Fund
____ Memorials & Tributes
____ Bequests
____ I wish this gift to be anonymous
____ Please keep me informed of ACGT news and activities.
Gifts should be made payable to ACGT. ACGT is a 501(c)(3) organization and all contributions are tax deductible.
©2007 Alliance for Cancer Gene Therapy 96 Cummings Point Road, Stamford, CT, 06902