Row for the Cure 2011 Donation Form

Name of Row for the Cure Participant: __________________________________________________________

Team Name: __________________________________________________________
DONOR INFORMATION: All information is kept confidential and will not be sold/marketed in any way.

Name:

Company Name: (for business donations)

Address:

City: State: Zip:

Phone (H): Email:

(Phone mandatory for credit card) (For receipt purposes only)
YOUR INVOLVEMENT:

YES, I will make a contribution to help the Row for the Cure for the following amount…

 $1,000  $500  $250  $100  $50  $25  Other Amount: ___________


PAYMENT:

Method of Payment:  Check (made payable to ARC Foundation Charitable Trust)

 Visa  Mastercard  American Express

Credit Card # 3 or 4 digit CVV2#: *

Signature: Expiration date:

If the credit card billing address is different from the mailing address please note the billing address below:

Name on Credit Card: _____________________________________________

Billing Address: ______________________________________________________________________________________________________

*To find CVV2#: On Visa or Mastercard, the CVV2 three-digit value is printed on the signature panel on the back of your credit card immediately following the card account number. On American Express, the CVV2 four-digit value is printed on the front of your credit card above and to the right of the card account number.
Credit card donations can be made directly online at www.headofthehooch.org/rowforthecure/ Click on SPONSOR A PARTICIPANT.

Please return form (and check if applicable) to the Row for the Cure participant you are sponsoring.

Or, mail donation form (and check if applicable) to:
Head of the Hooch-Row for the Cure, 1425 Market Blvd. Suite 330 - #244, Roswell, GA 30076

.

Attach your employer’s gift form for matching contributions.

I have read and understand the above.