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:
   
   Goatsbeard@cowtown.net
   
   
   
   

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 ___