Pennies in Action Donor Information

Pennies in Action® - Benefiting Dr. Brian Czerniecki's Breast Cancer Vaccine Research
	Enclosed is my tax-deductible contribution of $
	My Gift is in Memory/Honor of:
	Contribution is for the Pennies Club: yes no ($4.00 to Cancer Research, $1.00 to Aid for Veterans Wounded in Action) (Anything over $5.00 will go into the research fund.)
Name
Address
Address
City, State Zip
Phone Number
email
	Please make your check payable to: Pennies in Action Mail your donation to: Pennies in Action c/o IceWorks Skating Complex 3100 W. Dutton Mill Road Aston, PA 19014 attn: Uschi Keszler
	Your donation is fully tax deductible. Pennies in Action is a registered 501(c)(3) organization.
	An electronic Letter of Acknowledgement will be sent to you using the information above.
	Would you like your donation to be anonymous? yes no