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Printable Form for Donations and Sponsorships |
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| I WOULD LIKE
TO REFER A WOMAN WITH CANCER FOR A FREE DAY OR WEEKEND RETREAT : |
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| Please check one of the following: | |||
| Family Member Referral. | |||
| Personal Referral, such as a Friend. | |||
| Physician, Healthcare Professionals or Hospital. | |||
| Support Groups | |||
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Friend of A Time for ME: Donation/Sponsorship also enclosed (print form). |
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| Please check the box if you agree as true: | |||
| Upon submitting this referral, I declare that my candidate is aware that I are making the referral. | |||
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Candidate's name: |
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| Candidate's mailing address: | |||
| Candidate's phone number: | |||
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Your name (Referrer): | |
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| Your phone# or email address in case we need to contact you: | |||
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PLEASE MAIL YOUR REFERRAL TO: |
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A TIME FOR ME |
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Click here to Print page: |
Click here to Return to site: |
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| This page can
then be printed from any computer's browser by hitting the Print icon on
your taskbar. Choose print range 1-of-1 pages for most computers. Or from your keyboard, hit the two keys: Ctrl + P simultaneously to print the page. |
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A Time For ME is a non-profit organization: please read our Legal
section for additional information. |
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