Donation Form

Your gift to the UAB Comprehensive Cancer Center supports research and patient care at one of the nation's selected centers designated as "comprehensive" by the National Cancer Institute.

Donor Name (please print): ________________________________________

Address: _______________________________________________________

City, State, Zip: ___________________________________________________

Phone: _______________________ E-mail: ____________________________

___Enclosed is my check payable to UAB Comprehensive Cancer Center

___Please charge $___ to my (Please circle one) MC/VISA/AmEx/Discover

Account Number: _________________________________________________

Name on account: _______________________________ Exp. Date: _________

Signature: _______________________________________________________

Meaningful tributes of $25 or more will be promptly acknowledged to whomever you request. If this gift is in honor or memory of someone, please complete the information below.

(Circle one)In honor/In memory of: ____________________________________

Send acknowledgement to: _________________________________________

Address: ________________________________________________________

City, State, Zip: ___________________________________________________

Please mail donation to:
UAB Comprehensive Cancer Center
Office of Community Affairs
WTI - 1530 3rd Avenue South
Birmingham, AL 35294-3300

Thank you for your donation! All donations remain here in Alabama and go toward new and better treatments for all forms of cancer. All donations are tax-deductible as provided by law.

If you have any questions, please call the Office of Community Affairs at (205) 934-0282.