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2012 Butterfly Release Ceremony

We will be having a Butterfly Release Ceremony to remember and celebrate our 4p- children who have received their wings. The ceremony will take place on July 21st at Kammy’s Kause during our 2012 4p- National Conference. Please fill out the form below to have a butterfly released in your child’s memory. You do not need to attend the ceremony in order to have a butterfly released in your child’s memory. If you would like to ask a family member or friend who will be attending the ceremony to release the butterfly for you, please indicate that below in the Butterfly Releaser’s name field. We will be mailing each parent a memento of the ceremony after the event.

Your Name (required)

Email (required)

Phone Number (required)

Address (required)

City (required)

State/Providence (required)

Zip/Postal Code (required)

Country (required)

Child's First and Last Name (required)

Date of birth (required)

Date of death (required)

Will you be at the conference to release his or her butterfly? (required)
 Yes No Not sure yet

Butterfly Releaser's Name

Your Message

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