Donation by Check

Yes, I want to help fight NET Cancer and Carcinoid Syndrome. Enclosed is my tax-deductible donation for:

__$10     __$25     __$50     __$75     __$100     __$150     __$200     __Other

Please use this money to support:

Area of greatest need      Jimmy Fund Marathon Walk team

Walking with Jane Fund at Dana-Farber     ACS Relay Team     Scholarship Fund

__Please add me to your mailing list

Name

Address

City ___________________________ State______Zip__________

Country_______________________

Please print this form and mail with your check to Walking with Jane, Inc., Post Office Box 9721, Fall River, MA 02720

Walking with Jane is a 501(c)(3) non-profit corporation.