ADRP Inc., Registration Form

Afghanistan Dental Relief Project, Inc.,
A non-profit organization

Registration Form

Please print and return.

I would like to register for the ADRP newsletter and have it sent to the address below.

Name____________________________________________________________

Address___________________________________________________________

_________________________________________________________________

EMAIL _________________________________________________________________

You must have a valid email account to send and receive information about ADRP.

Please send this form to the Afghanistan Dental Relief Project Attn. Dr. James Rolfe
31 E. Canon Perdido St. Santa Barbara, CA 93101.

Or email this information to ADRP@VERIZON.NET

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