Yes, I want to help make a child's wish come true!

Title: Mr. Mrs. Ms. Dr.
Name:
Address:
City, State, Zip:
Phone Number:
Email Address:

I would like to donate:
$25 $50 $75 $100 other $
Sponsor a Clown Party for $100
Sponsor a Hospital Party for $250
Sponsor a Child's Wish for $1,500
Sponsor a Fun Center for $3,000

I am paying by:
Enclosed check (print this form)
Call me for payment information
Mastercard
Visa

Bankcard #:
Expiration:
Signature: ____________________________

Comments:


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