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For Cancer Information call

Your American Cancer Society Thanks You For Joining the Fight Against Cancer!
1-800-ACS-2345 or
visit www.cancer.org
RECEIPT FORM This donation represents a cash
(PLEASE PRINT)
contribution for:
 Cash  Check
Participant’s Name:
Amt Received $
( ) Dr. ( ) Mr. ( ) Mrs. ( ) Ms. ( ) Miss
Date Received
Last Name
Received By:
First Name
Home Address Team Name (if applicable)
City__________________________ State______Zip Donor - White Copy ACS - Yellow Copy
Home Phone An official receipt and thank you letter will be
issued provided donor information is complete.
Email Address

For Cancer Information call


Your American Cancer Society Thanks You For Joining the Fight Against Cancer!
1-800-ACS-2345 or
visit www.cancer.org
RECEIPT FORM This donation represents a cash
(PLEASE PRINT)
contribution for:
 Cash  Check
Participant’s Name:
Amt Received $
( ) Dr. ( ) Mr. ( ) Mrs. ( ) Ms. ( ) Miss
Date Received
Last Name
Received By:
First Name
Home Address Team Name (if applicable)
City__________________________ State______Zip Donor - White Copy ACS - Yellow Copy
Home Phone An official receipt and thank you letter will be
issued provided donor information is complete.
Email Address

For Cancer Information call


Your American Cancer Society Thanks You For Joining the Fight Against Cancer!
1-800-ACS-2345 or
visit www.cancer.org
RECEIPT FORM This donation represents a cash
(PLEASE PRINT)
contribution for:
 Cash  Check
Participant’s Name:
Amt Received $
( ) Dr. ( ) Mr. ( ) Mrs. ( ) Ms. ( ) Miss
Date Received
Last Name
Received By:
First Name
Home Address Team Name (if applicable)
City__________________________ State______Zip Donor - White Copy ACS - Yellow Copy
Home Phone An official receipt and thank you letter will be
issued provided donor information is complete.
Email Address
04-27 REV 08/02

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