Be an Awareness Sponsor

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Payment options appear after this form.

Please press the "Submit" button on the form above before making payment.  

Charitable Selection:

___ The LYN Fund:  Make check to "The LYN Fund"

___ Mammography Voucher Program:  Make check to "Morton Plant Mease Foundation"

Mail check and copy of this form to:

Charlene Mixa

5048 Pinnacle Drive

Oldsmar, FL  34677

For additional information, call:

727.753.3111

OR

Submit the form above and make a Charitable Selection below:

Select The LYN Fund:

Select Mammography Voucher Program:

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 by the ELW Drive for a Cure.  All rights reserved.  2019

FLORIDA REGISTRATION NUMBER CH60670:  ACOPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE.  REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE