PLEASE PRINT FORM ON YOUR PRINTER, FILL IN & MAIL

I WISH TO MAKE THE FOLLOWING CONTRIBUTION TO WISO

$_______Benefactor($100.00 or More)        $_______Patron($50.00 or More)

$_______Friend($25.00 or More)                   $_______Other Amount

Name____________________________________________________

Address__________________________________________________

Telephone__________________Email__________________________

Please Make Checks Payable To:  WISO

                                                           179 Anchorage Drive

                                                           West Islip, NY  11795

Thank You For Your Kind Support!