Enclosed
is my check for Donation
to Heartworks Photography, Inc.
Name
Street
City,
State, Country, Zip
City
State
Country
Zip
Telephone
Fax
Email
Amount
you wish to donate :
$
If
you would like your donation directed
to a specific hospital or city where we work please take
a look at our travel schedule and specify a location :
What
prompted you to donate? :
Additional
Comments :
Please
return form to :
Heartworks Photography Inc.
150 E. St. Charles Road
Carol Stream, IL 60188
Name