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Major Gift Donation

Donation Amount:

I would like my donation to recur:

Yes

Amount you would like to recur:

Frequency of donation:

Number of recurrences:

Date of your final recurring donation:

Please confirm recurring donation:

I would like to donate anonymously:

Yes

This donation is in tribute to:

This donation is in memory of:

Please show contributor(s) as:

You may use my/our name(s) in connection with Friends of ICAN materials:

Yes

No

I am willing to host a party for ICAN (20 to 50 attendees):

Yes

No

I would like to arrange a lunch or dinner with a prospective ICAN donor:

Yes

No

I/We want to become more involved with ICAN. Please call me/us to discuss volunteer and advisory board opportunities:

Yes

No

If you've met with a member of our ICAN Campaign Cabinet, please let us know so that they may join us in thanking you for your generous gift:

How did you hear about us:

Area of Interest: (specific cancer type):

This donation is a gift from:

President's Circle Sponsor: $50,000

Ambassador's Circle Sponsor: $25,000

Heritage Circle Sponsor: $10,000

Chairman's Circle: $5,000

Angel: $2,500