Bear-A-Thon Pledge Form 2014

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 April 5th at the O'Connell Center.
You need not be present to win.

For official rules click on the Honda Civic below.

* First Name  
* Last Name  
* Daytime Phone #  
* E-mail Address  
* City  
* State  
* Zip  
* How many bears would you like to donate?  
* Card #  
* Form of Payment  
* CVC# **  
* Name on card  
* Expiration Date on Card  
If you are paying by check, please make your check payable to Stop Children's Cancer.
Your total will be $40 x ____ bears.
Mail check to: K COUNTRY, 3602 NE 20th Place, Ocala, FL 34470
Your donation is tax-deductable and a receipt will be mailed to you.
Any message you'd like to share:  
**CVC# is on the back of your card.
It is 3 digits for MasterCard, Visa, and Discover.
It is 4 digits for American Express
Office use only: Car entry form(s) filled out __________.
Questions marked with * are required.

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