Dorough Lupus Foundation Wings of Hope Order Form

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*Note: If you don't have a printer, that's fine! Just send a note with all information* Please e-mail me at [email protected] before sending payment. Also, if you'd like to pay via Paypal, than please e-mail me your order. You will be e-mailed when I recieve your donation. Payment can be made out to Amanda Nelson OR Dorough Lupus Foundation. If you are including money to help pay for shipping, or if you are having the item giftwrapped, please make checks/money orders out to Amanda Nelson. Please send payment to the following address: Amanda Nelson 17407 Ironwood St. Arlington, WA 98223 Thanks for helping GBB and DLF!!!

Your Name: _________________________________________________________________________________ Is this a gift (circle one):      YES          NO If this item IS a gift, please write recipients name/address in place of your address If this order IS a gift, would you like it giftwrapped (extra $1):           YES                NO Your Address: _______________________________________________________________________________                      _______________________________________________________________________________                           _______________________________________________________________________________                      _______________________________________________________________________________ Your E-Mail: ________________________________________________________________________________ Copies of "Wings of Hope"  Ordered  __________________        (at $2 each, or 10 for $10) Would you like anyting special written on your poem?                _______________________________________        (this is optional - good for tributes, etc)                                                                                             _______________________________________                                                                                             _______________________________________                                                                                             _______________________________________                                                                                             _______________________________________                                                                                             _______________________________________ Other Instructions: ____________________________________________________________________________                             ____________________________________________________________________________ Total Cost for Books: _________________________ Shipping (optional): __________________________ Giftwrap (optional): _________________________ Total Donation: _____________________________________ Payment Made By (circle one):        Cash             Check            Money Order               Paypal

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