Long Beach Breast
Cancer Coalition
P.O. Box 844
Long Beach, NY 11561
Phone: (516) 943-3404

 



To complete this form - print out and return to:

Long Beach Breast Cancer Coalition
P.O. Box 844
Long Beach, NY 11561

Make check payable to: LBBCC

Name:______________________________________________

Address:____________________________________________
City:_______________________________________________
State:_____ZIP:________Phone:(____)___________________
Email:___________________@_________________________
If in honor of or in memory of individual(s) complete below:
Name:_____________________________________________

Send notice of donation to:
Name:_____________________________________________

Address:___________________________________________

City:________________________State:______ZIP:________

Your donation is greatly appreciated

Add my name to your mailing list ___ no thanks ___


   

 

website comments to