VCC Personal Gifts

To make a personal gift to help fight cancer, fill out this form, print it, and mail to the VCC:

Amy Gilman
Vermont Cancer Center
University of Vermont College of Medicine
The Courtyard at Given - Room N402
89 Beaumont Avenue
Burlington, VT 05405
Phone: (802) 656-8519

•Checks should be made payable to: Vermont Cancer Center.

•We also accept credit cards (MasterCard, Visa, AmEx, Discover).

Your donation to the VCC is tax deductible in accordance with IRS regulations.

About You
Salutation:
Your First Name:
Your Last Name:
Your Address:
Your City:
Your State or Province:
Your Zip Code:
Your Country:
Your Daytime Telephone:
How did you hear about us?
VCC newsletter:	Check this box if you would like to receive the free VCC newsletter. Please note, we do not share our mailing lists with other organizations.
Your Email Address:
Anonymous Gift:	VCC often recognizes major contributors in public to show our gratitude for their generosity. If this box is checked, your name will not be associated with your contribution.
Gift Information
I would like to make a gift of:	$10,000 $5,000 $1,000 $500 $250 $100 $50 $25 Other:

Credit Cards	If paying by credit card, please include the information below:
Credit Card:
Name as it appears on card:
Account #:
Expiration Date:	Month: Year:
Signature:

Thank you for your support!

Please print this form and mail to:

Amy Gilman
Vermont Cancer Center
213-E Given Building
89 Beaumont Avenue
Burlington, VT 05405

Giving

VCC Philanthropy 2008