
Please print the form and fill it out.
Make the check payable to Burn Survivors Throughout The World, Inc. or BSTTW.
Please remember to write on your check the specific BSTTW Fund you would like the donation to be deposited in. If you do not specify the fund, the donation will go directly to the BSTTW General Fund.
| Full Name: | |
| Address: | |
| City: | |
| State or Province: | |
| Postal Code: | |
| Country: | |
| BSTTW Donation Fund: | |
| Phone: | |
| Email Address: |