Women Making a Difference Membership Form

Please print this form and return in to the Coastal Community Foundation:
90 Mary Street, Charleston, SC 29403
Fax (843) 577-3671

Member Name

__________________________________________________________________________________


Home Address

__________________________________________________________________________________


Business Address

_______________________________________________________________________________
 
 
Home Phone (     ) ___________________________

Business Phone (      ) ___________________________

Mobile Phone (     ) __________________________

Fax (      ) ______________________________________

Email Address ____________________________________________________________________________________
**Important so that you can receive volunteer information and reminders about upcoming events**
 
 
Membership Preference (Full payment due by June 30; please indicate exact amount of pledge)

_____ Diamond Level $2,500+
 
_____ Emerald Level $1,000-$2,499
 
_____ Sapphire Level $500-$999
 
_____ Ruby Level $250-$499
 

Payment Method
 
_____ Check
 
_____ Credit Card #___________________________ Exp. ________________  


Type: Visa    MasterCard


Please sign if using credit card:

________________________________________________________________
 

If becoming a member by way of corporate sponsorship, please list name of sponsor so that WMD can acknowledge their contribution:

_______________________________________________________________

How did you hear about Women Making a Difference?

Please make checks payable to WMD Fund
Send form and check or credit card information to
Coastal Community Foundation, 90 Mary Street, Charleston, SC 29403

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