re+connect ornament drive
Support our re+connect fundraisers through purchasing a special re+active ornament! Each purchase goes to a unique person's need and helps provide care and equipment for people with neurologic disorders.
Email address *
Choose a campaign to support *
How would like your ornament? *
How many ornaments or dreidels would you like to purchase? (you will be directed to our purchasing page after this form) *
If you would like to make an other donation, please let us know here. *
Your answer
Contact info
Your name *
Your answer
Phone number *
Your answer
E-mail *
Your answer
Address *
Your answer
Never submit passwords through Google Forms.
This form was created inside of re+active physical therapy and wellness. Report Abuse