OFFICIAL  MOONLIGHT  BLOOD  DRIVE

VALIDATION  FORM 
 
 

NAME:

ADDRESS: 

CITY  &  STATE :

PHONE :

DONOR  SITE  LOCATION :

VALIDATION  STAMP  OR  SIGNATURE :

DATE :

  I understand that the information collected on this form will be used as proof

of my donation in Moonlight's name, and may be made available to Warner Bros,

agents of the cast members, the American Red Cross and National Blood Banks,

as well as any television networks or other media approved by the sponsors of

The Official Moonlight Blood Drive.

The donor agrees that all entities included above are not liable for the release of

this information to the parties listed.

Signature : ________________________________________________________________

Please mail completed verification form to: 

Christine Contilli - Sponsor

Official Moonlight Blood Drive

86 Great Oak Road

Brewster, MA 02631 

Thank you !