To receive a quilt please fill out the following information and email it to christine@mitoquiltsofhope.org
Name of Recipient:
Age of Recipient:
Full Address (including street, city, postal/zip code & country):
Are you willing to have your name and address released to the quilter for shipping purposes? Yes or No?
Phone:
Your Email:
Size: We make lap size quilts typically, if you have a special request regarding size please let us know. We will do our best to help out but cannot make any promises as larger sizes quilts are more expensive to make and costly to mail and also more time consuming to make.
Are you a member of the following organizations?:
- MitoCanada: Yes or No
- MitoAction: Yes or No
May we release your information to the following organizations?:
- MitoCanada: Yes or No
- MitoAction: Yes or No
A description of the recipient’s medical situation, diagnosis, and need for a quilt:
We would love to have a picture of you with your quilt. Please submit a picture to christine@mitoquiltsofhope.org
We anticipate a high demand for quilts and cannot promise when you will receive it so please be patient. The quilts will be distributed on a first come first served basis, although we do reserve the right to distribute a quilt on a high priority basis based on need.
