Families of SMA- Wisconsin Chapter
Balancing Life's Tough Times
Families of SMA- National Office
For One-Time
Donations
All rights reserved.
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Butterfly Order Form
* Required Field
Your
name:
*
*
Email:
Address1:
Address 2:
City:
State:
Zip/Postal Code:
If you are purchasing more than one
butterfly, please list the names of
those who will release them.This will
allow us to label them prior to the
date of the Walk & Roll.
Butterflies can be
purchased, for release, for
$10.00 each.  

Each butterfly comes in it's
own release package.

Payment must be received
by August 8th, 2007.

For late orders, please
contact Tiffany Diels @
(262)641-8849.  We will do
all we can to accomodate!


Checks should be mailed to:

Families of SMA
c/o Tiffany Diels
17655 Prince George Court
Brookfield,  WI  53045

Checks should be made
payable to: Families of SMA
(FSMA)