Instructions: Complete this form and email it to linda@BreatheEasyFoundation.org or mail it to Linda, Breathe Easy Foundation, 3651 North 100 East, Suite 300, Provo, UT 84604. For assistance call 800-992-7027 Monday through Thursday 10 – 4.
City, State ________________________________________ Zip __________________
Daytime Phone ___________________ Email _______________________________
List 3 Possible Dates ___________________________________________________
Desired Time of Presentation __________________________________________
Desired Address of Presentation ______________________________________
Anticipated Number of Attendees _____________________________________
I understand that the educational presentation about the deadly effects of air pollution poison is FREE except for travel expenses. I understand Breathe Easy will send me confirmation of the date and time, with an estimate of travel expenses, which expenses must be received by Breathe Easy one week prior to the expected date. Thank you.