Winship Cancer Institute Honor or Memorial Giving

Honor/Memorial Giving:

This gift is:

This gift is: Please Choose
In honor of
In memory of

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First Name:

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Last Name:

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Honoree or Next of Kin Information

We will send a letter acknowledging your gift to the person of your choosing. This can be the honoree, next of kin for a memorial donation, or someone else. Please fill in the recipient's information below.

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First Name:

Middle Name:

Last Name:

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Address 1:

Address 2:

City:

State:

Zip:

Relationship to the Honoree or Deceased:

I am a(n):

I am a(n): Family Member
Friend
Other

Gift Details:

Choose a gift amount above or enter your own amount: Required Field

Please designate my gift to: Required Field

Designations Other
Give to your area(s) of choice

Remove	Name	Amount	Percentage
	Friends of Winship Membership – Family ($100)	$	%
	Friends of Winship Membership – Individual ($50)	$	%
	Honor or Memorial Donation	$	%
	Winship at Midtown Capital Fund	$	%
	Winship Bone Marrow Transplant Fund	$	%
	Winship Brain Tumor Fund	$	%
	Winship Colon and Rectal Cancer Fund	$	%
	Winship Director's Fund	$	%
	Winship Discovery Fund	$	%
	Winship Genitourinary (Bladder & Kidney) Oncology Fund	$	%
	Winship Glenn Family Breast Center Fund	$	%
	Winship Gynecological (Ovarian, Endometrial, & Cervical) Oncology Fund	$	%
	Winship Head & Neck Cancer Fund	$	%
	Winship Leukemia Fund	$	%
	Winship Lung Cancer Fund	$	%
	Winship Lymphoma Fund	$	%
	Winship Melanoma & Skin Cancer Fund	$	%
	Winship Multiple Myeloma Fund	$	%
	Winship Ocular (Eye) Oncology Fund	$	%
	Winship Pancreatic and Liver Oncology Fund	$	%
	Winship Phase 1 Clinical Trials Fund	$	%
	Winship Prostate Cancer Fund	$	%
	Winship Sarcoma Fund	$	%
	Winship Way Fund	$	%
Total:	$0.00	0%

If you selected "Other" from above, please specify where your gift should be directed:

Are you using a corporate card for this gift?

If so, please provide company name:

I would like to make this a Recurring Gift

Personal Information:

Prefix:

First Name: Required Field

Middle Name:

Last Name: Required Field

Suffix:

Home Address Street 1: Required Field

Home Address Street 2:

City:

State/Province:

Country:

Zip/Postal Code:

Email:

Phone Type: Required Field

Phone Type: Business
Home
Mobile

Preferred Telephone: Required Field

(Phone Number Format: 123-456-7890)

Spouse/Partner Information

Spouse/Partner Prefix:

Spouse/Partner First Name:

Spouse/Partner Middle Name:

Spouse/Partner Last Name:

Spouse/Partner Suffix: