I want to help find a cure for
Cerebral
Palsy Please check one of the following: Address:
_______________________________________________
City:
Country:
_______________________________________________
Telephone:
_____________________________________________
Email
address: __________________________________________
Type of card: ___VISA ___ Mastercard
____AMEX ___Discover Card
Number: __________________________________________
Expiration
Date: ________________________________________ Name on
card: __________________________________________
Signature:
__________________________________________
Thank you for your generous support.

Mail-in Donation
(Printable Form)
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Enclosed is my check. ___ Please charge my credit card.
Name:
_________________________________________________
Please mail to this form to:
Inspire the World
Foundation
1015 Longview Avenue
Pismo Beach, CA
93449
Tel (805)
773-0951