2021 Cure Cancer Card Agreement
RequiredRequired Question(s)
(If there is more than one location, please fill this form out again for each location)
 
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Store Name:

 

50 characters left.
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Days and Hours of Operation (i.e. Mon - Sat 8AM - 8PM)

 

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Local Contact Name: 

 

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Contact Email: 

 

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Contact Phone (i.e. 210-555-1212):

 

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Store Street Address: 

 

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Store City:

 

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Store Zip Code: 

 

50 characters left.
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Store Phone (i.e. 210-555-1212):

 

50 characters left.
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Store Location:

1604 Vicinity
281 Area
Alamo Heights
Boerne
Castle Hills/NW Military
Comfort
Huebner Oaks & Vicinity
IH-10 Corridor
La Cantera Mall
North Star Mall Area
Olmos Park
Quarry / Lincoln Heights & Vicinity
Stone Oak & Vicinity
The Pearl & Vicinity
Other  

Mall / Shopping Area:

La Cantera Mall
North Star Mall
Sunset Ridge
Quarry Village
The Pearl
Other  

Store E-mail:

 

50 characters left.

Web Page:

 

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Please write a brief store description

 

350 characters left.

Exclusions:

 

350 characters left.

Restaurants should specify number of diners entitled to discount:

 

50 characters left.
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Categories (Please check only two boxes below that apply to your store):

Food / Dining
Sports / Fitness
Health / Personal
Women's Apparel
Men's Apparel
Children
Shoes
Jewelry
Art
Home Decor
Home Improvement
Specialty
Gift / Stationery
Sponsorships are available for $250. Sponsorship includes name listed on website, social media, printed materials and highlighted in all retailer lists.

I will contribute: 
$250 (Sponsorship)
(For other, please specify amount)
Other  

How would you like to make your contribution?

I will mail a check to SA Cancer Council by July 15, 2021.
I would like to pay online using the secure online payment option (link available on next screen, upon completion of this on-line contract)
This agreement confirms participation in the Cure Cancer Card (CCC) 2021 event run by the SA Cancer Council (SACC) to benefit the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center.

We agree:
* To offer a minimum 20% discount on regular retail prices from Friday, October 22, 2021 through Sunday, October 31, 2021, unless otherwise noted in the store exclusions.
* To promote the CCC by displaying materials provided (e.g., posters, brochure holders, and other marketing materials). We agree to advise all store personnel of these conditions and to train all personnel to promote the sale of cards.
* That the CCC is non-transferable and may be used only by the person whose name and signature appear on the card. Photo ID should be requested.
* That the SACC has no liability in connection with the Cure Cancer Card or otherwise.
* That this agreement and signature below confirms merchant's participation in the CCC 2020 event.
Exclusions if any, must be noted on this agreement.
 
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 Agreement Accepted by (Please type your name as electronic signature)


 

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Please enter your title (i.e. Store Owner)

 

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* If you have any questions, please contact us at (210) 450-5571.
* Retailer agreement also available on: www.sacancercouncil.org.
* Please complete this form on or before Thursday, July 15, 2021

SA CANCER COUNCIL
ATTN: CURE CANCER CARD
7979 WURZBACH RD, SUITE U600
SAN ANTONIO, TX 78229