Foundation Members
FOR GOVERNMENT AND CORPORATE EMPLOYEES ONLY
First Name *
Your answer
Last Name *
Your answer
Employee Number *
For VI Government Employees Only
Your answer
Name of your Department *
Your answer
Your Street or Mailing Address *
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
E-mail *
Your answer
Bi-weekly Contribution
Please choose which contribution you would like to make.
OPTIONAL
Please recognize me as a member and my level of contribution in your TakeTwelve Special Membership Edition.
Payroll Deduction for Foundation Members:
I would like my contribution to be deducted every pay period by my payroll division and mailed to you on my behalf.
Interested in Volunteering
Please indicate which activities interest you.
Check all that apply:
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