Printable General Donation Form
If you prefer to pay by check,
please print & mail this completed form.
Or, if you prefer to pay immediately On-Line, please Click Here.
I would like to participate in Gilda's Club Desert Cities as a contributor. My donation will help Gilda's Club Desert Cities reach people living with cancer and their families and friends in the community.
Name:
Address:
City, State, Zip:
Phone:
My check payable to Gilda's Club Desert Cities is enclosed.
OR
My credit card information is:
Visa #: Exp.
Date:
Mastercard #: Exp. Date:
American Express #: Exp.
Date:
Name on the
card:
Amount of Gift to be charged to my Credit Card: $__________
Gilda's Club Desert
Cities
67-625 E. Palm Canyon Dr., Ste.
7A
Cathedral City, CA
92234
(760) 770-5678
Office
(760) 770-5667
Fax
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