STITCHES
Release Form
STITCHES Womens Iniaitives 28056 Palomino Drive
Warren, MI 48093 Phone: 586-873-8034
Releas
e and
W
aiv
er
Fo
r
m
Stitch
es
W
o
m
en
’s
I
n
itiativ
es
TH
IS
IS I
N
F
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MAT
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IS
C
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FID
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TI
A
L
Eng
l
i
sh/
E
sp
an
ol
N
am
e
/
N
o
m
b
r
e:
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_________
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______
_
_________
______
______
_
_________
______
_____
S
t
r
e
et
A
dd
r
es
s
:
______
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_________
______
______
_
_________
______
______
_
_________
______
___
C
i
t
y
/
C
i
ud
a
d:
______
____
________
S
t
at
e
/
E
st
a
d
o
:
_
______
____
_
Z
i
p
/
Post
a
l
C
od
e_____
____
_______
E
m
a
il
/
I
n
t
e
r
n
e
t
:
y
o
u
w
a
nt
to be a
dde
d
to
ou
r da
ta
ba
se
:________________
____________________
I
g
r
an
t ST
I
T
C
HE
S W
o
m
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it
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t r
estrictio
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ter
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all
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as
ST
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it
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licize
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ST
I
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w
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b
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ite.
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ST
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ST
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D
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in
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ee
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ta
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ar
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th
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ctio
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,
d
is
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ib
u
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a
n
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c
a
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ll a
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d
an
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ated
p
r
o
m
o
t
i
o
n
al
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r
o
r
g
a
n
iz
at
io
n
al
m
a
ter
ia
l.
