Bear-A-Thon Pledge Form 2015

Your generous donation of $40.00 assures that every child
being treated for cancer at the University of Florida
Shands Cancer Center receives a soft cuddly bear or chemo duck.
Since its founding in 1981 by the Freeman Family,
Stop! Children's Cancer has been locally managed
and dedicated to raising funds for basic research scholars
and equipment for the
Divisions of Pediatric Hematology/ Oncology
and Pediatric Neuro-Oncology at the
University of Florida College of Medicine.

For each $40 bear or chemo duck donation you make
you will receive one entry to win
a brand new Honda Civic courtesy of 
Honda of Gainesville
to be given away at this year's Fantasy Event
on May 9th at Santa Fe River Ranch
You need not be present to win.

For official rules click here
* Number of Bears  
* Number of Ducks  
* First Name  
* Last Name  
* E-mail Address  
* Phone Number  
* Address  
* City  
* State  
* Zip  
* Number of Bears/Ducks x $40 = $_____ (total donation)  
* Form of Payment  
If paying by check, please enter 0 for the following 4 fields.
* Card #  
* Expiration Date on Card  
* Name on Card  
* CVC#  
MC, Visa, Discover CVC is the 3 digits found on the back of card
Am Express CVC are the 4 digits found on the front of card
Make checks payable to: Stop Children's Cancer, Inc.
Mail check to: K COUNTRY, 3602 NE 20th Place, Ocala, FL 34470
Any message you'd like to share:  
Your donation is tax-deductable and a receipt will be mailed to you.
Office use only: Car entry form(s) filled out __________.
Questions marked with * are required.

Doug Rockwell
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