Message you wish to send:
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Your Name: ____________________________________________________
Mailing Address: ________________________________________________
City, State, Zip: __________________________________________________
Email: ________________________________________________________
_____ Check enclosed
_____ Please charge my ___ Visa or ___ Mastercard
Account #: ______________________________ Exp.: _________________
Name on card: ________________________________________________
Amount: $________________________
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Research Fund you are donating to:
___ MTC ___ General
Please mail to:
ThyCa: Thyroid Cancer Survivors' Association, Inc.
PO Box 2327
Allen, TX 75013