President's Circle Gift Form

  • President's Circle

    Thank you for making an executive decision to fight cancer by making a gift through the President's Circle to Dana-Farber Cancer Institute. Your leadership level gift of $1,500 or more is supporting cutting-edge research and lifesaving patient care. President's Circle members are recognized for the gifts they make to Dana-Farber's Annual Fund during the current fiscal year: Oct. 1 - Sept. 30.

    If you have any questions, please contact Annual Giving at 617-632-6099 or

I would like to make a monthly gift and join Jimmy's Team.
Monthly Gift Amount *   
NOTE: This transaction will be charged to your credit card monthly.
I would like to make a single gift for the following amount:
$1,500 - Circle of Hope
$2,500 - Circle of Courage
$5,000 - Circle of Innovation
$10,000 - Circle of Progress
$25,000 - Circle of Discovery
Other $
Total annual giving of $1,500 or more qualifies you for membership in the President's Circle. Donors with total giving of $2,500 or more during Dana-Farber’s fiscal year are listed in our annual Honor Roll of Donors.
Other: *   $
I am making this gift in honor or in memory of someone  (Click To Expand)

Please use the following fields to indicate whom your gift is honoring or memorializing.

I would like to dedicate this gift to:



ZIP/Postal Code:
This gift is:

Gift From:

Person to Notify Name:

ZIP/Postal Code:
Direct My Gift to Support

Your gift will be directed where it is needed most, unless you select a designation below. If you would like to support an area not listed below, contact Donor Services at 617-632-2903 or

  • Area of greatest need
  • Family Wishes
  • Basic Research
  • Bone Marrow Transplant Program
  • Cancer Prevention
  • Early Drug Development Center
  • Gastrointestinal Cancers
    • Colon Cancer
    • Colorectal Cancer
    • Esophageal Cancer
    • Liver Cancer
    • Pancreatic Cancer
    • Stomach & Gastric Cancers
  • Genitourinary (Urinary/Men’s Reproductive) Cancers
    • Bladder Cancer
    • Kidney Cancer
    • Prostate Cancer
    • Testicular Cancer
  • Global Health
    • Center for Global Cancer Medicine
    • Global Health Initiative (Pediatric)
  • Head and Neck Cancers
    • Head and Neck Cancers
    • Thyroid Cancer
  • Hematologic (Blood) Cancers
    • General
    • Acute Lymphoblastic Leukemia
    • Leukemia
    • Lymphoma
    • Multiple Myeloma
    • Non-Hodgkins Lymphoma
    • Waldenstrom’s Macroglobulinemia
  • Immunology
  • Melanoma
  • Neurological Cancers
    • Brain Tumor—Adult
    • Brain Tumor—Pediatric
    • Neuroblastoma
  • Patient Assistance
    • Patient Assistance—Adult
    • Patient Assistance—Pediatric
  • Pediatric Oncology
  • Profile Genetics Analysis
  • Psychosocial Oncology & Palliative Care
  • Sarcoma and Bone Cancers
  • Survivorship
    • Survivorship—Adult
    • Survivorship—Pediatric
  • Thoracic (Lung) Cancer
  • Women's Cancers
    • General
    • Breast Cancer
    • Gynecologic Cancer
    • Ovarian Cancer
  • Zakim Center for Integrative Therapies
About You

Please use your full, legal name rather than a nickname.

Please enter all information exactly as you want it to appear on all correspondence.

First Name: *
Middle Initial:
Last Name: *
Email: *
Address Line 1: *
Address Line 2:
City: *
State: *
ZIP/Postal Code: *
Country: *
Phone: *
Company Name:
Matching Gifts Click here to see if your employer will match your gift.
Business Phone:
Cell Phone:
Check this box to have timely program and event information sent directly to your cell phone! Msg & data rates may apply. Max 2 msg/wk.
Payment Information
: *
: *
: *    Explain
Credit Card Type: *
Credit Card Expiration: *
Credit Card Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
: *
: *
: *
Country: *
Additional Information
How did you hear about us?: *
I/we have included Dana-Farber in my/our will:
I/we would like information about including Dana-Farber in my/our will:
Why do you give?:
If you would like to notify someone of your gift, please include tribute information in section after the gift amount.

Type the characters you see in the picture below:*
By clicking Submit,
your credit card will be processed