Your donation will help the IIIB’s accomplish their mission to provide every woman in America who is facing breast cancer today, valuable and convenient medical information, recovery items and emotional support contained in our Bosom Buddy Basket at the time of diagnosis free of charge.
 Each $150 donation will help provide a Bosom Buddy Basket to one deserving breast cancer survivor. 

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Gift Amount:

I would like to support the IIIB's Foundation now with my one time tax deductible contribution of:

$50   $75  $100  $150   $500   $1000   Other Amount: $

 

How did you hear about the IIIB's Foundation?:

From:

If you selected "Other" please indicate how you heard about us:
 The more details the better!  This will help us improve our marketing.  Thank you.

If you selected "Basket Recipient" please indicate where you received your basket:
  

Please provide the following billing contact information:

Title
*First Name  
*Last Name  
Middle Initial  
Company Name
*Street Address  
*City  
*State/Province  
*Zip/Postal Code  
*Country  
Cell Phone
*Home Phone  
*E-mail  

Payment Option:

Visa               MasterCard

     

 

WE ARE TEMPORARILY UNABLE TO ACCEPT CREDIT CARDS OVER THE INTERNET.  ONCE YOU "SUBMIT" THIS FORM, PLEASE CALL CAROLYN AT 703-327-9677 TO SUBMIT YOUR CREDIT CARD INFORMATION FOR PROCESSING.  WE APOLOGIZE FOR THE TEMPORARY INCONVENIENCE.   WE WILL FULFILL YOUR ORDER AS SOON AS WE PROCESS YOUR PAYMENT.

Select any of the following options that apply:

I wish to receive future email correspondence.
 I prefer to make my donations anonymously.
 Would you like to include the dollar amount in the acknowledgement?

Will your contribution be matched by your employer?

Acknowledgement Information:

Please use the following name(s) in all acknowledgements stating who the donation was given by:

I would like my donation to be inHonor orMemory:

If your gift was in honor or memory of a cancer survivor, would you like an email sent notifying the cancer survivor, a family member or a friend of your donation? If yes, please enter email address(es) to send acknowledgement:


If you are including multiple email addresses, please separate addresses with a comma.

May we publish your donation information?

You can include my donation information on the IIIB's Foundation website and other marketing material.  If you answered yes, please check the following:

Include the name(s) stating who the donation was given by.
 Include the donation amount.
 Include the person the gift is in honor or memory of.

 

No, please do not include any information about my donation on the website.

 

The IIIB's Foundation, a division of Family Focus of Richmond County, Inc. is a national 501(C)(3) charitable organization.
Contributions to the IIIB's Foundation are tax deductible to the full extent allowed by law.