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

I want to participate in the VPF’s Support Network. (The VPF will send you contact information for a volunteer Leader in your area.) 

Please send me __________ additional VPF brochures.

							


Name



Address



City / State or Province / Zip or Postal Code



Country


Telephone Number (home)


Other Number

(cell, facsimile, please specify)

									

									
E-mail address

									

									

									Profession or business



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 Drawer 177

						
Graham, NC 27253
USA

			
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