“Joanna A. Nichols Dance for the Cause”
2009 Dance‑A‑Thon!

Sunday, November 8^th from 2:30 – 4:00

Registration begins at 1:30

DONATION FORM

First Name:______________________________________    Last Name:_________________________________

My goal is to raise at least $ _____ for the American Cancer Society for my participation in the Joanna A. Nichols Dance for the Cause 2009 Dance a Thon.

Dear Potential Sponsor,

I am participating in the “Joanna A. Nichols Dance for the Cause” Dance-A-Thon. This event is to raise funds and awareness for cancer and the proceeds will help fund cancer research, education, etc.  I am collecting donations for the American Cancer Society and all checks should be made payable to the American Cancer Society. All contributions to the American Cancer Society are tax-deductible.  If you pay in cash and require a receipt, please provide your full information below.  Thank you for your contribution.

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Name of Sponsor		Street, City, State, Zip	Donation	Collected? (check)	For cash donations, receipt requested? (check)
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