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"Breeders' Cup or Bust" Contribution Form

The Paulick Report, in association with Breeders' Cup Charities, is proud to be able to raise awareness for the Permanently Disabled Jockey Fund and the V Foundation for Cancer Research through their Breeders' Cup or Bust cross-country fundraiser. Setting up events at Keeneland, Hawthorne, Remington Park, Zia Park, Turf Paradise and Santa Anita, they hope to raise a significant amount of money to help ease the pain of those jockeys who have been tragically disabled and continue the fight to find a cure for cancer.

The Paulick Report, in association with Breeders' Cup Charities, is asking people to donate one of two ways. Since Ray and Brad of the Paulick Report are driving from track to track, you can interact with the Breeders' Cup or Bust cross-country fundraiser by making a donation per mile. If you prefer, you can also make a one-time donation of any size to help these two great causes.

Please fill out the following information to make a contribution to Breeders' Cup Charities. If you have any problems making your contribution, you may e-mail Breeders' Cup Online Support for assistance.


Step 1. Name and Contact Information
* First Name   * Last Name  
Address 1 Address 2
City * State  
* Zip / Postal code   Country
* Date of Birth     * Gender
 
* E-mail   * Confirm E-mail  

* You can use my name for charity promotional purposes
* Please include my e-mail address in future Breeders' Cup mailings, promotions and giveaways.
* I want to receive special offers, product info and other e-mail from BreedersCup.com sponsors and partners.
* How would you like to receive your newsletter?


Step 2. Contribution Amount

Contributing a penny a mile or more will enter you into a drawing for one of five Breeders' Cup hats signed by the winning jockeys of all 14 Breeders' Cup races!

Support Level:
Per Mile Amount $. per mile (2,835 miles)
Flat Amount $

Your Total Donation

$28.35

Step 3. Form of Payment


 
Card Number: Billing Address 1:
Security Code:   What is this? Billing Address 2:
First Name
on Card: 		City:
Last Name
on Card: 		State:
Expiration Date: Zip:
    Country:

* Breeders' Cup uses AVS (Address Verification System) to help protect you against credit card fraud. All credit cards submitted require that your billing address exactly match your credit card billing address on your statement.

OR



Breeders' Cup Charities - Breeders' Cup or Bust
2525 Harrodsburg Road
Suite 500
Lexington, KY 40504