The Juan A. del Regato Foundation welcomes your support for its activities.  Donations are tax deductible, and will be applied entirely to fulfilling objectives in education, history, and international understanding in the field of radiation oncology.  As a contributor or honoree, you will receive an invitation to the annual lecture and regular reports on activities supported by the Foundation.  Your gift will enhance a unique effort in the field.

DONOR INFORMATION

Date:_____________     Donor Name:_________________________________________

Amount of Donation:_________

        This donation is in memory of:__________________________________________

        This donation is in honor of:____________________________________________

                    HONOREE INFORMATION

                    Please notify:__________________________________________

                    Street Address:_________________________________________

                    City:________________________  State:_____  Zip:__________

                    Relationship to Honoree:_________________________________

Please make checks payable to Juan A. del Regato Foundation and mail to:

J. Frank Wilson, M.D.
Medical College of Wisconsin
Dept. of Radiation Oncology
8701 Watertown Plank Road
Milwaukee, WI  53226

For tax purposes, a receipt of your donation will be mailed to you.

Thank you