To raise money for and promote breast cancer research
To set a new FAI Women's World Record in October 2002.
To make a donation by credit card online, using PayPal, please click on this button. Note: Customers outside the U.S. who do not already have a PayPal account will need to sign up for PayPal separately (http://www.paypal.com) before making a Web Donation payment. Customers within the U.S. may sign up for a PayPal account during the Web Donation process. There is no charge to sign up for an account:
If you prefer, you may mail this form with your check or credit card information to:
Jump For The Cause 2002
P.O. Box 261068
Encino, CA 91426-1068
or you may print out this page and simply fax it to us with your credit card information: 818-781-1364, OR call 818-781-1354 and leave this information on our voice mail. For your records, our Non-Profit/Federal Taxpayer ID number is #95-4732083.
[To download a Microsoft Word version of this document that you can print, click here]
YES! I would like to support your efforts to benefit Breast Cancer Research at the following level:
___ $280 ($2 per participant) ___ $100 ___ $20
___ $140 ($1 per participant) ___ $ 50 ___ Other $____
___ My Check is enclosed (make payable to Jump for the Cause)
___ Charge my credit card (complete all information below for credit card processing)
Name:_________________________________________________
Address:_______________________________________________
City:________________________ State:___________ Zip: ______
Phone: _______________________
[Check one:]
___ MasterCard ___ VISA ___ American Express ___ Discover
Charge Card Number__________________________ expiration date______
Name as it appears on card _________________________
Cardholder Signature _____________________________
Please participate in honor of / memory of _________________________
This donation should be credited to the account of:
(name of participant) _____________________
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