Can you please,
STAND UP FOR A CURE!
FULL NAME
BILLING ADDRESS
CITY
STATE
...
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
ZIP
PHONE
EMAIL
HOW DID YOU HEAR ABOUT US?
CREDIT CARD NUMBER
EXPIRES
...
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
...
2008
2009
2010
2011
2012
CARD CODE
AMOUNT YOU WISH TO DONATE
*Denotes required information
FOR CORPORATE SPONSORSHIP
Contact us at (212) 209-3871
STAND UP FOR A CURE
708 Third Avenue, 6th Floor
New York, NY 10017
Phone: (212) 209-3871
Fax: (212) 209-7123
info@sufac.org
