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