Cookin' for Wishes

Registration Form

May 19th, 2004

Donation: $50 per person (One form per person , please)

Name:______________________________________

Address:______________________________________

City:___________________________Zip________

Phone:______________________________________

E-mail:______________________________________

Fill out this form completely and bring or mail with your check/visa information to: Specialties Showroom, 2800 West Eleven Mile Road, Berkley MI 48072 or register by phone with your Visa/Mastercard 248-548-5656. Registrations will not be accepted without payment. Make checks payable to: Make-A-Wish Foundation.

Payment Method:   

Check number _______________ for $50 is enclosed.    

Charge my ____ Visa _____ Mastercard  (check one).     

Account number:_________________________________   

Exp:_____/_______