Van Bourgondien

Getting Started Form (Fundraising Material)

Email: (required)

Name: (required)

Organization: (required)

Address Line 1: (required)

Address Line 2:

City: (required)

State: (required)

ZIP Code: (required)

Phone: (required)

Promotion Code:

The promotion code is found on the label of your Starter Kit

Number of Members: (required)

Approximate number of members in your organization participating in the fundraising event

Van Bourgondien P.O. Box 2000 Virginia Beach, VA 23450 1-800-622-9997