|
Just
Plain Folks Organization, Inc. |
|
Without Communications a heart suffers! |
|
Copy this
application into your word processor
or an E-Mail Message, fill it out, attach your documentation, and send
it to us! It’s that easy. |
|
Computer
Application—Individual Information Today's Date:
_______________ Name of Individual:
__________________________________________________ Home Address:
___________________________________________________ City:
________________________ State:___________ Zip:
__________________ County:
______________________ Mailing Address (if
different): __________________________________________ City:
________________________ State:___________ Zip: __________________ Home Phone: (______)
_________________ Work Phone: (______)
_________________ Cell Phone: (______) __________________ E-Mail:
______________________________ Fax: (______)
_________________________ Relationship to individual if your not the
recipient: ______________________________________________ Detailed Nature of
Recipient's Disability: (Attach Documentation) If selected to receive a computer, you may
be photographed, and your name, image and likeness may be used to publicize
on the Internet. By signing below, you
waive any rights of privacy in connection with JPFO. By signing you are
attesting that all information is true and correct. _________________________________ (Signature) Mail Applications
to: Just Plain Folks
Organization, Inc. c/o Jerry and Tracy
Babione 1105 E. 57th Street Stillwater,
Oklahoma, 74074 |