Tristan Lippmann Donation Fund


                                                $10 Each (includes shipping)


Name: ___________________________________________________________

Shipping Address: ___________________________________________________________

City: ___________________________ State: ____ Zip code: ____________

Email and/or Phone: ____________________________________________

(in case of any ordering/shipping issues)

Please indicate shirt color:     _____ White     _____Black

Please indicate quantity for each size:       

____ S           ____M          ____ L           ____ XL

Total number of shirts: _____

Total amount enclosed: _____

Please mail this completed form along with your check made out to the The Tristan Foundation  to:
                                                           96136 Light Wind Dr

Fernandina Beach, FL 32034

You may also email the information to us ( and send the check separately. Shirts will not be shipped until payment is received.

We will contact you once your t-shirt ships. Please expect 2-3 weeks for delivery. Thank you for supporting the Tristan Fund!