Name & address:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Meeting or other religious affiliation:

____________________________________________________________

I/we enclose

___$50  ___$100  ___$200  ___$500  $_______other

for the FWCC general budget.

I/we enclose

___$50  ___$100  ___$200  ___$500  $_______other

as a restricted gift to the Wider Quaker Fellowship program.


___  I/we prefer to support WQF without receiving mailings.

___  I/we do not need an acknowledgment for the enclosed contribution.


Send    Wider Quaker Fellowship mailings in
      
               ___ Spanish /   ___ English...

        a sample information packet on WQF in

               ___ Spanish /   ___ English...

___  to my/our address, above.

___  to the address below (my/our friend/s, family 
     member/s, colleague/s, etc.).

___  I/we enclose an explanatory note for you
     to include with the welcome packet.

____________________________________________________________

____________________________________________________________

____________________________________________________________