Sponsor a membership

First Name (required)

Last Name (required)

Address

Your Email (required)

Name of sponsored individual

Email of sponsored individual

Date

City

State

Zip

Phone

Chronic illness

Cushings SyndromeOther Illness

If other illness, please write here

Family?

Family member

How did you hear about The EPIC Foundation

Birthday

This form is to sponsor a membership of $35

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