Donation card wording

There was an awesome thread a few weeks back where a bunch of people posted the wording for the donation cards they're including with their favors. Many included a mention of a deceased loved one who was being honored by name.

Can anyone help me out with sample wording? We're making a donation to the Susan G. Komen breast cancer foundation in lieu of traditional favors. I'm debating whether to mention FH's mom on the donation favor card- or how to put add it as a nice touch.

Thanks!