EmailMe Form - iPad, iPod Touch, Tablet Information Form

Child's Name

Child's Birth Date

Are you interested in an iPad, iPod Touch or other tablet?

Child's Challenge(s):

Do you have specific Apps you are planning to use for communication and/or education?

How do you think an iPad/iPod Touch will change your child’s life?

Upload a picture of your child (not required)

How did you hear about us?

We are starting a pilot program for one of the options to raise funds. We will have catalogs that you can put in waiting rooms in your community of doctors offices, service businesses like Discount Tire, hair salons anywhere people have to wait for services. For example, you can find 20/25 places to leave 10-20 catalogs. Most of establishments are happy to help with the effort.

The catalogs will be FREE to you. There will be a way to include your personal story of why you are raising the money or you can keep it anonymous. There will be a code on the catalogs that you put out so you would get credit for the sales that are made.

If you want to be more proactive, you could have a catalog "party" but it will not be required. We will also give you an electronic version of the catalog you could forward to people you think would support your efforts.

If you earn more than an iPad cost, you could earn iTunes cards to purchase apps and accessories to go with the iPad, for example a case.

If you are interseted, please respond yes, and include the name of your town and state.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Email *

Twitter

Phone

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