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Epic Experience General Donations

Epic Experience seeks to engage individuals whose lives have been affected by cancer in the healing process by providing a retreat where participants can experience adventure, seek solace in the peaceful surroundings, and establish a supportive community among fellow survivors.

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:
 

Are you a cancer survivor?
Are you a caregiver?
Thank you for your generous donation and helping with our Epic mission.
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: