Boyds Bears from Brittany's Hope Foundation

Name 

Address 



City                             State         Zip              

Email (optional) 


____ Please add my name to your mailing list.
    (Brittany's Hope never releases your information to anyone.)


	
I would like to purchase:

____ Patrick Flag Bearer Figurine     Donation: $ _____________

____ Thomas Drummer Figurine          Donation: $ _____________

____ Mason Plush Bear                 Donation: $ _____________

____ Dixon Plush Bear                 Donation: $ _____________

Total Donation Amount:       $ ________________________________





Please mail this form and your check made payable to:
Brittany's Hope Foundation
1160 North Market Street
Elizabethtown, PA  17022