104 SE 12 Street Deerfield Beach, FL 33441 954.254.9311 fax 954.570.5593 email info@lindseyrae.com Please complete the following form: I would like to be on the Lindsey Rae mailing list I would like to volunteer my time to kid's events. I would like to volunteer my time to fundraising efforts. I would like to make a tax deductible donation.   $ Name Address City   State   Zip Email Phone   Fax I have a child with Down syndrome Yes No     My child's age is Child's Name Date of Birth NONE CHECK VISA MASTERCARD Name on Card Credit Card # Expiration (Format: MM / YY)

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