Your information is safe. Blacktie does not sell or share any information about you or your purchase. In addition, you should see a little padlock in the corner of the screen. This indicates that this site is protected by a Secure Socket Layer and that your credit card or electronic check information can't be intercepted as you enter it. All fields are required unless otherwise noted.

Cancer League of Colorado – Membership Information

Cancer League of Colorado appreciates your membership and support!
First Name:
Last Name:
Title (optional):
Organization (optional):
Address:
City:
State:
(ignore for non-US transactions)
Zip Code:
Country:
Email Address:
Confirm Email Address:
Preferred Phone:
Credit Card Billing Address
 
 If the address where you receive the credit card bill is different than above, please enter it here.
Address:
City:
State:
Zip Code:
 


What is the name of your significant other?

Salutation for formal mailing?

Please enter your cell phone (xxx-xxx-xxxx) or enter NONE

Please enter an alternative email address or enter NONE

Please enter your Company Name:

Please enter your Company Title:

Please enter your business address, including city, state and zip:

Please enter your business phone (xxx-xxx-xxxx)

Please enter your business fax number

Please enter your first year of membership:

Please indicate your areas of volunteer interest below
Addressing Bridge Board Member CARE Comm. Corporate Board
Golf Tournament Hospitality/Hostess Membership Race 4 Research
Spring Benefit Sponsorships Over the Edge Writing Other

My talents include: (ex. Fundraising, Accounting, Law, Communications, etc.)

I/we have already included Cancer League Foundation in my/our estate plans:
Yes No

Please send me information about the ways to make an estate gift to Cancer League Foundation:
Yes No

Charge Amount:
  Other Amount --> $
  You can choose any amount you'd like by checking the box for the amount you'd like to give, or by checking the Other option and entering a custom amount in the blank field.
Make this a Recurring Transaction? By default your card will only be charged today, with no recurrence set up. However, you can use the fields below to specify a recurring payment on the schedule of your choosing. Change the recurrence to specify how often your transaction will be processed. Specify an end date to stop transactions after a certain point in time (if you are unsure, use the expiration of your credit card).
Recurrence:
End Date:
Pay by Credit Card  
Card Type:
Credit Card Number:
Credit Card Expiration (mm/yy): /
Name On Card:
C V V Value: