Payment By Check
One-Year (6 issues) Subscription Form
First name
Last name
Mailing Address:
City:
State: Zipcode
Email Address:
Billing Phone Number (xxx-xxx-xxxx)
Subscription Donation Amount:


"Florida residents, please add 6% sales tax

 Additional Donation
Designate Charity
Please complete and print this form and mail it with your check (made payable to either Jackson Memorial Foundation or UM/Sylvester) to: 
Cruising for a Cure 
c/o Porthole Cruise Magazine 
4517 NW 31st Avenue 
Fort Lauderdale, FL 33309-3403

To Print this Form, Simply Select Print for your Browsers File Menu