Locust Grove Funeral Home Memorial Donation Form The Leukemia & Lymphoma 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: The Leukemia & Lymphoma Society Please mail completed form and donation to: The Leukemia & Lymphoma Society Oklahoma Chapter 3613 N.W. 56th St., #230 Oklahoma City, OK 73112 |
For more information, call 1-800-955-4572,
or visit www.leukemia.org