EMPOWERED Cookies and Coffee Order Form
We can’t wait to EMPOWER you with delicious cookies and coffee.  Simply complete one form for each order and we’ll handle the rest.  Feel free to contact us at powelldrescher@gmail.com with any questions.  And thank you for EMPOWERING ovarian cancer research!  
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Email *
Your Name
Your mailing address (please include city, state and zip!)
Your email address
Cookies and Coffee Selection
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To whom are we delivering? (full name, please)
Where should we deliver? (complete address, please, including city, state, and zip)
On which date should we deliver?
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What should the tag say?  (To whom, from whom?  If no information is provided the default will be "Happy Holidays from The Powell-Drescher Foundation")
How would you like to pay?
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