Support the Spina Bifida Association of North Carolina!
Buy a "Dream With Me Tonight" Music CD!

Please print and complete this form and mail with $15 each (includes shipping) to:
SBANC,
3915 Grace Court,
Indian Trail, NC 28079

Please make check or money order payable to SBANC.
We cannot accept credit cards at this time.
Allow 3 weeks for delivery.
Questions? Please call 704-882-0988 or e-mail sbanc@mindspring.com



Name: _______________________________________________

Mailing Address: ______________________________________

City: _______________________________________________

State: ____  Zip Code: _________________

Telephone: (________) __________________

e-mail: _______________________________


Shipping Address ________________ 
(Complete below if different from mailing address):

Name: ______________________________________

Mailing Address: ______________________________

City: _______________________________________

State: ____  Zip Code: _________________

PLEASE SEND ME THE DREAM WITH ME TONIGHT MUSIC CD
Quantity
Please accept my tax deductible donation
Total Enclosed

.(____________)  X $15 (includes shipping)

(_$ _____________________________)
.
 Privacy Statement: The Spina Bifida Association of North Carolina does sell your contact information to outside parties. It will only be used by SBANC.

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