Thursday, September 09, 2010

Inheritance of Hope Interest Form

Please submit this form if your family or a family you know could potentially benefit from the services of Inheritance of Hope. THIS FORM DOES NOT INCUR ANY OBLIGATION OR COMMITMENT. This is simply a way that you can make us aware of families to contact about our offerings.

Inheritance of Hope serves families having children 18 and under AND a parent diagnosed with a life-threatening illness. Our services to these families include literature, speaking engagements, and all-expenses-paid Legacy Retreats. Please submit an interest form only for qualifying families.

Interest Form

Family Information

Diagnosed Parent's Name
Diagnosed Parent's Title
Age
Spouse/Caregiver Name
Street Address
City
State
ZIP Code
Family E-mail Address
Family's Phone Number

Children in the Family

Child Name
Age

Referral Information

Your Title
Your Name
Your Email
Your Phone Number
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