Bipolar Awareness Wristband Order Form

The black and white wristband contains the words “Prechter Bipolar Research Fund.” The wristbands are intended to raise both awareness and needed funding.  All proceeds from the sale of the wristbands benefit the Prechter Fund at the University of Michigan Depression Center and support breakthrough research aimed at conquering bipolar disorder.

Wristbands may be purchased in quantities of 10 for $50.00 per bag, plus a $5.00 shipping and handling fee.

To order by check, please send this form and payment (payable to “Prechter Bipolar Research Fund at U-M” ) to:

Kat Bergman
University of Michigan
Heinz C. Prechter Bipolar Research Fund
Office of Medical Development and Alumni Relations
1000 Oakbrook Drive, Suite 100
Ann Arbor, Michigan 48104-6815
 

Quantity of wristbands (# bags of 10/bag): __

Name:________________________________________

Mailing address:________________________________

_____________________________________________

Phone:_______________________________________

E-mail:_______________________________________

If you wish to pay by credit card, please contact:
Kat Bergman at (734) 763-1440 or  kbergman@umich.edu.

Thank you for your help in raising awareness about bipolar disorder and for your support for bipolar research.