Friend Memberships ($45)

The VP Foundation Friends Membership ($45)

I want to receive The VP Foundation Newsletter and other information from the Foundation.

Please send me __________ additional VPF brochures.

Name


Address


City / State or Province / Zip or Postal Code


Country


Telephone number


E-mail address


Profession or business


How are you related to the sufferer?


How did you hear about the Foundation?




Please print out a copy of this form and mail with
your fee of $45 plus international postage, if any, to:

The VP Foundation
Post Office Box 755
Graham, NC 27253
USA


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