MAIL IN MEMBERSHIP FORM

Thank you for becoming a member of Wings For Children. Please print out the form below, enclose your check, money order, or credit card information, and mail to:

Wings For Children
1900 Oak Street
P.O. Box 1962
Myrtle Beach, South Carolina 29578

Name: ______________________________

Street Address: __________________________________

Apt No. (if appl): __________

City: _______________________    State: ______

Zip Code: _________    Telephone: ___________________

__ 25.00    __ $50.00    __ $75.00    __ $100.00    __ $150.00
__ Other (Please specify): ___________

Method of Payment: 
__ MasterCard    __ Visa    __ Money Order     __ Check
(Do not send Cash!)

Card No.: ________________    Expiry Date: ____    Year: _______

__ Please include my name on the Wings For Children Volunteer List.

Ideas or suggestions:
_________________________________________________
_________________________________________________
_________________________________________________

Signature: __________________________    Date: ________