"The Challenge" Pin Order form

Click here for info on "THE CHALLENGE" effort        Click here to read about DNA Banking

NAME: ____________________________________________

ADDRESS:  ________________________________________

CITY: _____________________________________________

STATE:  ___________________________________________

ZIP: ______________________________________________

DAY PHONE:_______________________________________

EVE. PHONE: ______________________________________

E-MAIL: ___________________________________________

Print and complete this form
Send with check or money order
in U.S. funds to:

AWL Challenge Fund
c/o Pam Tobin
720 Bear Creek Road
Libby, MT 59923
e-mail: tobinpam@libby.org
phone: (406) 293-8688

AWL, a non-profit 501 (c) 3 organization,
 is acting vehicle for "The Challenge" funds,
 making all contributions tax deductable.

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