Lung Cancer Research Foundation

YOUR CONTRIBUTION WILL HELP MAKE A DIFFERENCE
We welcome your tax-deductible contribution to support lung cancer research. Your gift will advance the mission of the Lung Cancer Research Foundation. You can personalize your donation by using our easy form. Simply select a type of gift and complete the form below. To make your donation by check, please click here.

I WOULD LIKE TO MAKE THE FOLLOWING TYPE OF GIFT:
TRIBUTE GIFT GENERAL GIFT

I WOULD LIKE TO DONATE:
Amount *

MY GIFT WILL BE:

A one-time donation

A monthly gift

NAME AND ADDRESS:

Title *

First Name *

Last Name *

Country

Company Name

Address *

Suite/Apt. Number

City *

State *
Zip *

Phone

E-mail Address *

I WOULD LIKE TO DEDICATE MY DONATION:
	In Memory of In Honor of
Title *
Tribute First Name *
Tribute Last Name *
On the Occassion of

I WOULD LIKE LCRF TO SEND AN ACKNOWLEDGEMENT OF MY GIFT TO:

Title

First Name

Last Name

Country

Address

Suite/Apt. Number

City

State
Zip

Contribution Note

CREDIT CARD INFORMATION
Name on Card *
Card Number *
Expiration Date *	YYYY-MM
Card Type
Security Code *

BILLING ADDRESS:

My billing address is same as above.

Title *

First Name *

Last Name *

Country

Address *

Suite/Apt. Number

City *

State *
Zip *

Phone

E-mail Address *

Please click here if you prefer to donate by check.

Make your check payable to LCRF and mail to:
845 Third Avenue
6th Flr.
New York, New York 10022

If you need additional information, please call 646.290.5154 or email donations@lungfund.org

DOUBLE YOUR DONATION: (Optional)

Please type in the name of your employer below to see if your gift can be matched through your company's matching gift program.

If your company is not listed, we encourage you to contact your Human Resources office to inquire if the Lung Cancer Research Foundation can be added to your company’s list of eligible charities.

I WOULD LIKE TO BE PLACED ON THE LCRF MAILING LIST:

Yes

How did you hear about us?:

A copy of our most recent audited financial statement is available upon request by writing to the Lung Cancer Research Foundation, 845 Third Avenue, 6th Floor, New York, NY 10022