Thomara Latimer Cancer Foundation Donor Contribution Form

Donor Dr. Rev. Mr. & Mrs. Mr. Mrs. Ms. Miss Telephone
Address City/State/Zip

This gift is for: (Please check all that apply)
Homecare assistance Assistance with final arrangements Medication/Treatment
Transportation Scholarship funds

I am We are submitting this gift in memory of in honor of
Please mail notification card, if needed to: Dr. Rev. Mr. & Mrs. Mr. Mrs. Ms. Miss
Address City/State/Zip

Please find enclosed my gift of (made payable to the Thomara Latimer Cancer Foundation)
Contributions are tax deductible