To submit a name for the Cloud of Witnesses Quilt, fill and and mail in the following form:   Givers Name:  _______________________________________________________________ Address:  ___________________________________________________________________ City:  _______________________________  Zip:  ___________________________________ Phone Number: __________________________  Email:  ___________________________   Name of Your Witness:  ______________________________________________________                            (circle one)           In Memory of             or              In honor of   **  if you want us to let the witness or their family (circle one) know of this honor, please provide the appropriate contact information: Name:  __________________________________________ Address:  _______________________________________ _________________________________________________ Please send this form and check payable to:  BWIM, NC, C/O JJ Johnson, Treasurer                                                                                   2719 Gordon Street                                                                                   Raleigh, NC 27608 Thank you for your suppoer of BWIM, NC's 25th Anniversary Celebration and the Kay Simpson Memorial Endowment.