1. Supporter Name
Address
City State Zip
Phone ( ) Email
Start collecting today! Ask your friends and family to support you by purchasing daylilies.
Proceeds will help raise money for the Epilepsy Foundation of Indiana!
Bronze Package ($25.00) Silver Package ($50.00)
5 Live Plants of Assorted Daylilies (Bare Root) 10 Live Plants of Assorted Daylilies (Bare Root)
Gold Package ($75.00) Platinum Package ($100.00+)
15 Live Plants of Assorted Daylilies (Bare Root) 20 Live Plants of Assorted Daylilies (Bare Root)
Shipping Address /
Name Phone # Email Address Package Total $
OPTION: in honor of or in memory of (please specify):
Make checks payable to Epilepsy Foundation of Indiana
Waiver: In consideration of my being participating in the Epilepsy Foundation of Indiana Fundraiser, I hereby release the Smokeys Daylily Gardens, Epilepsy Foundation and its affiliates (collectively the “Sponsor”), from all liability which may arise
out of my participation in the Epilepsy Foundation of Indiana Fundraiser and I agree to indemnify and hold harmless the Sponsor from all liability and expense arising out of such participation I hereby waive all rights of action which I, my heirs, or
representatives may have against the Sponsor or any other person connected with the Epilepsy Foundation of Indiana Fundraiser. I FULLY ASSUME ALL RISKS AND RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON
OR PROPERTY THAT COULD OCCUR AS A RESULT OF MY PARTICIPATION IN THE FUNDRAISER.
Signature of Participant________________________________________ Date___________