Name:___________________________Address: _____________________________________________
Phone:___________________Email: ______________________________________________________
Yes! I will help fight blood cancers by making a 100% tax-deductible donation to the Leukemia and Lymphoma Society, in recognition of the efforts of team member, Ginny Dufrene. Ginny is running 26.2 miles in honor of Ramona Harrell and other L&L patients. In addition to making the tax deductible donation to LLS, I understand that my name will be submitted to a drawing for a guided fishing trip (Golden Meadow, LA) with Dufrene’s Guide Service. www.dufrenesguideservice.com
I will donate:
___$500.00 = 50 tickets ___$200 = 13 tickets ___$150= 9 tickets ___$100= 6 tickets
___$75 = 4 tickets ___$50.00 = 3 tickets ___$25.00 = 1 ticket $_________ Other
Your name will be submitted to the drawing for the corresponding number of tickets purchased. The winner will be notified on the day of the drawing. Please be sure to include all contact information at the top.
My company would like to sponsor Ginny, and have our logo on the back of her jersey by giving a Corporate Sponsorship (you will be contacted for additional info):
___ Bronze Medal Sponsor: $500 ___ Silver Medal Sponsor: $1,000
___ Gold Medal Sponsor: $5,000
___ My Check is Enclosed
___ AMEX/MC/Visa #________________________________
Exp. Date______ Cardholder___________________
Signature_____________________________________
I would like to make this contribution, and for Ginny to run in honor of a family member or friend with cancer:
Name: _____________________________________ Age:____________________
Relation:____________________________________
Diagnosis:___________________________________
Please check out
www.active.com/donate/tntms/gdufrene
to monitor my progress!
You can even donate online! Make checks payable to: LLS or Leukemia & Lymphoma Society.
Mail to: 15-A Thames Lane Purvis, MS 39475
