Locust Grove Funeral Home Memorial Donation Form American Cancer Society Complete and print using your browser's 'Print Page' function; then send with your donation to the address provided below. The family will receive a notice that your donation was made in memory of their loved one. Pre-printed memorial envelopes are also available at the funeral home. |
Date |
(mm/dd/yyyy) | |
Enclosed is $ |
||
| In Memory of | ||
| Please Notify (Family Member Name) | ||
| Mailing Address | ||
| City, State, ZIP | ||
| Gift is from (Your Name) | ||
| Mailing Address | ||
| City, State, ZIP | ||
Phone Number |
(xxx-xxx-xxxx) |
| Make checks payable to: American Cancer Society Please mail completed form and donation to: American Cancer Society Heartland Division, Inc. 6440 S. Lewis, Suite 100 Tulsa, OK 74136 |
For more information, call 1-800-ACS-2345,
or visit www.cancer.org