Information Request

Use this form to request information such as our newsletter or receive more information about our programs. Click "Done" when finished.

Please feel free to give us a call at 360-690-8495 or email us at info@projectpatch.org if that would make it easier to communicate and answer your questions.

Question Title

* 1. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What are you most interested in?

Question Title

* 3. What information would you like?

Youth Program - Girls'

Youth Program - Boys'

Family Program (Family Experience)

Seminars

Making a donation to Project Patch

Brochures

Newsletter - PATCHworks (3 times a year) - Electronic

Newsletter - PATCHworks (3 times a year) - Mail

Address Correction/Chage

Other (please specify)

Question Title

* 1. Address

Question Title

* 2. What are you most interested in?

Question Title

* 3. What information would you like?

Question Title

* 4. Other Information: