© 2019  by Bria Fund ™ Supporters for FIP Research

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2016 AIN’T NO STOPPING US NOW RAFFLE PRIZE DONATION FORM

 

Please complete this form for each prize to be donated. After completing the form, please send a photo of the item to defeatFIP@verizon.net

 

 

Name of Donor:

 

 

E-mail:

 

 

Telephone Number:

 

 

Country of Residence:

 

 

Name of Item to be Donated:

 

 

Description of Item:

 

 

Will mail prize to winner, if located within my country of origin? Yes  No 

 

 

If winner is in a different country, will split the cost of mailing with the winner? (Assistance can be provided to help determine most economical postage rate). 

Yes  No

 

 

Please contact Susan Gingrich at defeatfip@verizon.net with any questions. You will receive a confirmation of your completed form. Thank you very much for your prize donation and participation in the fight to end FIP!

 

Don’t forget the photo!