I want to receive The VP Foundation Newsletter and other information from the Foundation.
I want to serve as a resource for the Foundation in my field or specialty. (If you want to be available to patients, please send a resume, brochure of your practice, and/or letter about your background to the Executive Director.)
Please send me __________ additional VPF brochures.
City / State or Province / Zip or Postal Code
Telephone Number (Work)
Best times to call
Field (Medical doctor, physical therapist, scientist, psychologist, etc.)
How did you hear about the Foundation?
Please print out a copy of this form and mail with
your fee of $60 plus international postage, if any, to:
The VP Foundation
Post Office Box 755
Graham, NC 27253