DONATION FORM

(Print out and complete)

 

 

Name _______________________________________________________

Address _____________________________________________________

City __________________________________ State ____  ZIP _________

Phone ______________________ email_____________________________

Mail form to:

Ludington Visiting Writers

310 N. Ferry St.

Ludington, MI 494321

Visa                Mastercard                Check

Amount to be donated ___________________________________________

Card number ____________________________ Expiration date __________

_______________________________________ Date _________________

Signature

 

 

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