Friend Memberships ($45)

Friend Memberships ($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? What related condition do you have?

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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