If you would like to make a donation, please print and fill out the following form and return to the Wytheville office in person or mail it to PO BOX 628 Wytheville, VA 24382.


Checks can be made out to "Friends of Anne B. Crockett-Stark"

Driving Forward to General Assemply 2009!




Donation Form

Friends of Anne B. Crockett-Stark


PO BOX 628
Wytheville, VA 24382

 

Name: _____________________________              Date: _____________

 

(If Applicable)

Company/Affiliation: ____________________________________________

 

Position:_______________________________________________________

 

Address:_______________________________________________________

 

Phone: ________________________________________________________


Donation Amount: _______________

 

Comments: ____________________________________________________


Your support is greatly appreciated! 

"Working to create an environment of opportunity for the Sixth District."

 

It's Gotta Be... Annie B.!
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