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Northeast Council of W.I.C.C.A.
Wiccans Interested in Creating Community Awareness
Mail-In Support Contribution |
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and complete this form, and mail it along with your check or money order
made payable to Northeast Council of W.I.C.C.A. to P.O. Box 357, North
Greece, New York 14515. Please use your browser's back button to
return to referring page. |
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Last Name
___________________ First
Name ____________________
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Business /
Organization _________________________________________
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Address 1
________________________________________ Apt.
_____
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Address 2
___________________________________________________
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City
____________________________ State
_____ Zip________ |
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Phone ( ____ )
____________ E-Mail ____________________________ |
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Your
privacy will be respected. Please see our Privacy
& Security Page for additional information. This
information is required in case we need to contact you about your
contribution.
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Thank You For Your
Support |
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I
understand that my contribution of $________ is not yet tax
deductible, that
a $25.00 fee is charged for all checks returned to us unpaid, and
acknowledge
that I am at least 18 years of age. |
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c
Please publish the following information in the Sponsor Directory
on
your web site. If you
prefer not to use your legal name, list preference here:
Listing
Name _____________________________
E-Mail
Address____________________________
Website URL
_____________________________
c
Thank you, but I would prefer that my information not be
published.
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_________________________________________________________________
Northeast Council of W.I.C.C.A.
Wiccans Interested in Creating Community Awareness
P.O. Box 357 • North Greece, New York
• 14515
http://www.necofwicca.org
info@necofwicca.org
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