EmailMe Form - WISH Champions 2016

Name (as it should appear in print collateral) *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone

### - ### - ####

Employer Name/Title

Briefly List your career and/or philanthropic achievements: *

What is your greatest personal accomplishment? *

What's your word? How would family and friends describe you in one word and why? *

What's your favorite way to spend free time? *

What interests you most about helping to grant a wish through Make-A-Wish? *

What's your passion? *

WISH CHAMPION COMMITMENT

By typing my name below, I acknowledge that I have reviewed the information packet and accept the role of WISH Champion and membership in the 2016 class. I commit to raise $7,500, the funds needed to grant a wish to a child with life-threatening medical conditions in our local community.

I commit to attending one of the two Kick-Off events scheduled on October 6 and October 8, 2016, the Celebration Luncheon on February 4, 2016 and will partner with Make-A-Wish staff to meet or exceed my goal.

I will also provide the staff with a high resolution headshot photograph as well as a professional/personal bio to be included in the printed Celebration Luncheon program.

By typing my name below, I acknowledge that I have reviewed the information packet and accept the role of WISH Champion and membership in the 2016 class. I commit to raise $7,500, the funds needed to grant a wish to a child with life-threatening medical conditions in our local community.

I commit to attending one of the two Kick-Off events scheduled on October 6 and October 8, 2016 and the Celebration Luncheon on February 5, 2016 and will partner with Make-A-Wish staff to meet or exceed my goal.

I will also provide the staff with a high resolution headshot photograph as well as a professional/personal bio to be included in the printed Celebration Luncheon program.

For questions, or to fax and mail/fax this form, please contact:

Janis Netherland, Director of Philanthropy, Wilmington
Make-A-Wish Eastern North Carolina
3602 Lydford Ct.
Wilmington, NC 28409
O: (910) 399-1375
F: (919) 832-0079
E: jnetherland@eastnc.wish.org
W: www.eastnc.wish.org

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