e-mail
to usDONATION and MEMBERSHIP
FORM
If
you are interested in sharing some of your love as a member
or
are interested in making a donation, please fill out the
form
below.
ANNUAL
MEMBERSHIP FEE IS ONLY $20.00
Any
size donation is welcome!
Please print out this form
send it with your check/money order
made payable to:
RHODE ISLAND ASSOCIATION FOR
CARDIAC CHILDREN
P.O. Box 3904
North Providence, RI 02911
(or call 401-353-3966)
__________________________________________________________________
Name: ___________________________________________________________
Street: ___________________________________________________________
City: _____________________________________________________________
State: ____________________________________ Zip: ___________________
Telephone # Day: __________________________ Night: _________________
Amount enclosed ___________________________
Please check one: ___ Donation ___ Membership
THANK YOU!
