With a $48 donation to the Daisy Institute, you will expeditiously receive one cream of your choice, sent anywhere on the globe by air-mail, wherever public mail can reach.
Simply fill out the form here, in clear letters, and send it, along with your donation, to the Daisy Institute address below here:
Daisy Institute
6525 Wilderton Ave. Suite 710
Montreal, Qc. H3S 2L4 Canada
E-mail: daisyinstitute@daisyinstitute.com
tel. (514) 733-2408
Family Name:__________________________Given Name:_______________
Company/Organization:___________________________________________
Street Address:_________________________________________________
________________________________________________Apt.#___________
Town/City:______________________________________________________
State/County/Prov.:_____________________________________________
Country:_______________________________Postal/ZIP Code:_________
Date____________________________________________________________
Check the appropriate box with your donation, and indicate your choice and number of cream(s)
| $48 | $96 | $86 | other |
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