Your contributions are essential. If you would like to help or simply make a donation, print out the form below and mail to:

The Adelphi NY Statewide Breast Cancer Hotline & Support Program
Adelphi University School of Social Work
1 South Ave, PO Box 701
Garden City, New York 11530-0701

Yes, I would like to become involved with the Adelphi Breast Cancer Support Program. I would like to: (please circle)

• Volunteer for the hotline/outreach/advocacy
• Join a support group
• Discuss services for my company
• Be added to your mailing list
• Receive your newsletter
• Support the program. Enclosed please find my gift of:

$500	$50	other: ____________
$100	$25
My gift is in honor of: __________________________________________ My gift is in memory of: ________________________________________
	I'd like to purchase: ____Teen Video(s) at $38 each:___________
Name ____________________________________________________________ Address __________________________________________________________ City_____________________________________ State_____ Zip____________ Phone (w)__________________________ (h) ___________________________ Please print, fill out and mail to the address above or email us at: breastcancerhotline@adelphi.edu.