Vidanta Ambassador's Certificate Deposit
Thank You for donating your Vida Ambassador Certificates to Send Me On Vacation. We sell these certificates at a higher price than the required maintenance fee needed to activate the certificate. We use the additional monies to generate the funds needed to support our gifted vacations for survivors. Please fill out the form for each week that you would like to donate. Your donation makes it possible for more breast cancer survivors to rejuvenate their body, mind and spirit post treatment.

*Please note: We hold our travel auctions quarterly and not all certificates are purchased. Although we do our best to encourage the sale of these weeks, we cannot guarantee that all weeks will be purchased by the expiration date. We continue to develop programs to encourage the sale of the weeks to support our mission.
Sign in to Google to save your progress. Learn more
Email *
Maintenance Fee if Applicable
First Name *
Last Name *
Vidanta Ambassador Membership Contract Number *
Number can be found on your Ambassador Membership contract.
Are you depositing more than 1 certificate? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of iMDirect Marketing.