2006 - 2007 Friends of the Englert Enrollment Form

Become a Friend of the Englert!

Please complete the form below to enroll in Friends of the Englert. An Englert staff member or volunteer will contact you to complete your enrollment.

GIVING A MEMBERSHIP AS A GIFT?
Simply fill in the information for the person(s) you are giving it to, and enter your email address in the "Email Address" field AND your name/phone number in the "Employer Matching Company Name" field. We will contact you to get payment details, and your gift recipient will receive a card in the mail informing them of your gift.

If you would like to contribute in other ways, please contact:

Sean Fredericks
Managing Director
(319) 688-2653 x105
sean@englert.org

First Name*
Last Name*
Address*
City*
State*
Zip*
Phone*
Email Address*
On Behalf Of*	IndividualHousehold
Name Acknowledged*	Anonymous
Donation Amount*
Payment Method*	Credit Card - Please CallCheck
Employer Matching
Employer Matching Company Name
	*=required information
	Please type the letters you see below.