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Mail completed form to: Cancer Prevention Coalition Dr. S.S. Epstein, School of Public Health, University of Illinois at Chicago 2121 W. Taylor St. Chicago, IL 60612 www.preventcancer.com email: epstein@uic.edu YES, I'd like to Join the Coalition! Please find my contribution (tax deductible) in the amount of: $35 $100 $1000 Over $1000 $100 (office-Regional or local) I would also like to donate to the following resource(s): 1. 2. 3. 4. Name:____________________________________ Address:__________________________________ City:________________ State: ______ Zip: ______________ Phone: ________________ Fax: _______________________ Email: ____________________________________________ Processed Through: The Connection9520 St. Andrews Drive, Santee, CA 92071 (877) 334-7443 email: health@bodymindconnection.com