Fill out this form, print and mail to:
Pamela M. Werner, CFRE
Executive Director of Development
UC San Diego Health Sciences
9500 Gilman Drive #0853
La Jolla, CA 92093-0853
The UC San Diego Foundation is a 501(c)(3) non-profit organization.
Tax ID: 95-287-2494
| Donor Information |
| Title |
First Name
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Last Name
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| Company Name (if appropriate) |
Phone (999) 999-9999
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email (abc@mysite.example)
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| Address |
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City
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State
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Zip
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| Commemorative Gift |
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Name of Honoree |
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| Send notification of this gift to: |
| Title |
First Name
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Last Name
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| Company Name (if appropriate) |
| Address |
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City
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State
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Zip
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| Gift Information |
| *Gift Amount $ *Confirm Gift Amount: $ |
| My check made payable to the UCSD Cancer Center Foundation is enclosed. |
| Please use my Credit Card |
Credit Card Number: |
| Exp. Date: / (mm/yy) Signature___________________________________________ hco |
| *Please tell us where to direct this gift. |
| For the Cancer Center's greatest needs. For the following area of cancer research and care. |
This completed form should be mailed to:
Pamela M. Werner, CFRE
Executive Director of Development
UC San Diego Health Sciences
9500 Gilman Drive #0853
La Jolla, CA 92093-0853 |
For additional questions, please contact Pam Werner at (858) 246-1566 or pmwerner@ucsd.edu. |
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