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2009 DONATION FORM                                                                                                               For Official Use Only

                                                                                                                                                                        Participant ID: 1323269
                                        Mrs. Claudia Ann Lindsey                                                                                                        Event ID: 1300
                                       Name of Participant You’re Sponsoring
                                                                                                                                                                      TAX ID NUMBER 23-7825575

INSTRUCTIONS
• Send only one check per donation form and only one donation                                                                                        PLEASE MAIL THIS FORM
  form per check.                                                                                                                                    wITH YOUR DONATION TO:
• Please make all checks payable to “Breast Cancer 3-Day” and write
  the Participant ID number on the memo line.                                                                                                        Breast Cancer 3-Day
• All donations are non-refundable and non-transferable.                                                                                             PO BOX 650543
• All donations are tax deductible to the extent allowed by law.
• Donations cannot be split amongst participants or teams.                                                                                           Dallas, TX 75265-0543
• We cannot accept cash donations. Please convert cash to a money
  order or check.
• We can no longer accept credit card donations via mail. Please visit our
  website at www.The3Day.org to make a donation with a credit card.
• International checks and international money orders are not accepted
  via mail. Please visit our website at www.The3Day.org to make an
  international donation.
• Please do not send your donation via Fed Ex or other
  delivery methods.


1. DONOR INFORMATION.


FIRST NAME                                                                                                          LAST NAME (For corporate donations, write company name in the last name field.)


MAILING STREET ADDRESS                                                                                              SUITE/APT. NO.                  CITY


STATE            ZIP                                   PHONE                                                                                                       m I would like more information about
                                                                                                                                                                        how to apply for a matching gift.
                                                                                                                                                                   m Don’t add me to your contact list.
DONOR EMAIL ADDRESS (If an email address is provided you will receive a receipt via email. We do not sell or share your information.)


2. CHOOSE YOUR LEVEL OF DONATION.
INSPIRATION: Donation of $501+                                                       SUPPORTER: Donation of $100 - $500                                                  FRIEND: Donation of $5 - $99
Single payment in full:                                                              Single payment in full:                                                             Single payment in full:
                                                             .                                                                          .                                                             .

3. ATTACH CHECK.
Please remember to attach only one check per donation form.


CONTACT US: To register or for more information about the Breast Cancer 3-Day including state-specific financial disclosures, call
800.996.3DAY or visit www.The3Day.org.


MATCHING GIFTS: Many companies provide their employees with matching gifts. After you make your donation, mail your matching gift
form, Breast Cancer 3-Day donation receipt and Matching Gift Checklist (available at www.The3Day.org) to: NPT Breast Cancer 3-Day,
165 Township Line Road, Suite 150, Jenkintown, PA 19046-3593. For matching gift questions call 800.996.3DAY.


ABOUT THE BENEFICIARIES: Eighty-five percent of the net proceeds from the Breast Cancer 3-Day benefit Susan G. Komen for the Cure,
the world’s largest and most progressive grassroots network fighting to end breast cancer. Fifteen percent of the net proceeds from
the Breast Cancer 3-Day benefit the National Philanthropic Trust Breast Cancer Fund, a special field of interest fund that will provide
support for breast cancer initiatives including research, treatment, prevention and education.


BE A HERO—TELL AS MANY wOMEN AS POSSIBLE ABOUT THE LIFESAVING BENEFITS OF EARLY DETECTION AND TREATMENT OF BREAST CANCER.
© 2009 Breast Cancer 3-Day. SKU#BC3000                                                                                   Thank you for supporting the fight to end breast cancer.

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20093 Day Donation Form

  • 1. 2009 DONATION FORM For Official Use Only Participant ID: 1323269 Mrs. Claudia Ann Lindsey Event ID: 1300 Name of Participant You’re Sponsoring TAX ID NUMBER 23-7825575 INSTRUCTIONS • Send only one check per donation form and only one donation PLEASE MAIL THIS FORM form per check. wITH YOUR DONATION TO: • Please make all checks payable to “Breast Cancer 3-Day” and write the Participant ID number on the memo line. Breast Cancer 3-Day • All donations are non-refundable and non-transferable. PO BOX 650543 • All donations are tax deductible to the extent allowed by law. • Donations cannot be split amongst participants or teams. Dallas, TX 75265-0543 • We cannot accept cash donations. Please convert cash to a money order or check. • We can no longer accept credit card donations via mail. Please visit our website at www.The3Day.org to make a donation with a credit card. • International checks and international money orders are not accepted via mail. Please visit our website at www.The3Day.org to make an international donation. • Please do not send your donation via Fed Ex or other delivery methods. 1. DONOR INFORMATION. FIRST NAME LAST NAME (For corporate donations, write company name in the last name field.) MAILING STREET ADDRESS SUITE/APT. NO. CITY STATE ZIP PHONE m I would like more information about how to apply for a matching gift. m Don’t add me to your contact list. DONOR EMAIL ADDRESS (If an email address is provided you will receive a receipt via email. We do not sell or share your information.) 2. CHOOSE YOUR LEVEL OF DONATION. INSPIRATION: Donation of $501+ SUPPORTER: Donation of $100 - $500 FRIEND: Donation of $5 - $99 Single payment in full: Single payment in full: Single payment in full: . . . 3. ATTACH CHECK. Please remember to attach only one check per donation form. CONTACT US: To register or for more information about the Breast Cancer 3-Day including state-specific financial disclosures, call 800.996.3DAY or visit www.The3Day.org. MATCHING GIFTS: Many companies provide their employees with matching gifts. After you make your donation, mail your matching gift form, Breast Cancer 3-Day donation receipt and Matching Gift Checklist (available at www.The3Day.org) to: NPT Breast Cancer 3-Day, 165 Township Line Road, Suite 150, Jenkintown, PA 19046-3593. For matching gift questions call 800.996.3DAY. ABOUT THE BENEFICIARIES: Eighty-five percent of the net proceeds from the Breast Cancer 3-Day benefit Susan G. Komen for the Cure, the world’s largest and most progressive grassroots network fighting to end breast cancer. Fifteen percent of the net proceeds from the Breast Cancer 3-Day benefit the National Philanthropic Trust Breast Cancer Fund, a special field of interest fund that will provide support for breast cancer initiatives including research, treatment, prevention and education. BE A HERO—TELL AS MANY wOMEN AS POSSIBLE ABOUT THE LIFESAVING BENEFITS OF EARLY DETECTION AND TREATMENT OF BREAST CANCER. © 2009 Breast Cancer 3-Day. SKU#BC3000 Thank you for supporting the fight to end breast cancer.