Contributions are tax-deductible to the extent allowed by law. The campaign is
administered by the National Transplant Assistance Fund, a 501 (c)(3) nonprofit
providing fund raising assistance to transplant and catastrophic injury patients.
Information 1-800-642-8399
Car - Bike Show Registration Form
REGISTRATION FEE $20.00

NAME:____________________________________________________________________

FULL ADDRESS REQUIRED
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EMAIL : ___________________________________________________________________

PHONE : __________________________________________________________________

VEHICLE INFORMATION

YEAR___________ MAKE _______________ MODEL __________________

PLEASE LIST ALL SPECIAL FEATURES
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MAKE CHECKS PAYABLE TO:

NTAF Kidney Transplant Fund
MEMO SECTION :  IN HONOR OF- LLOYD SCOTT

SEND TO;
DEBBIE JONES - COORDINATOR
PO BOX 3042
MIDDLETOWN N.Y. 10940