Information Form


  1. You can print this form to fill out and mail to:

    Fort Worth Via Media
    P.O. Box 101212
    Fort Worth, Texas 76185

    Or...

  2. Copy it to an email and send to:

    bgclick@gmail.com



Information Form

Name:

Address:

Parish Affiliation

Home Phone:

Day Phone:

Fax:

E-mail Address:

Please subscribe me to the Fort Worth Via Media discussion list: ____

I want to support the work of Fort Worth Via Media with a donation in the sum of $____

I want to donate to the Fort Worth Via Media Legal Fund with the sum of $____

I am interest in helping Fort Worth Via Media in the following ways: {Check as many as apply.]

Prayer ___ Strategy ___ Legal ___

Publicity ___ Membership ___ Research & Communications ___