Wakefield High School Education Foundation

Name: ____________________________________________________________________
	First 			Maiden 			Last


Address: _________________________________	Enclosed is my contribution for $ _________________

City: ______________________________________	__ I am a member of the WHS Class of ____________

State: ____________________ Zip: ____________	__ I am a past or present staff member ____________

Home Phone: ______________________________	__ I am a parent, spouse or friend of a member of the

E-Mail: ___________________________________	class of ____________

						__ My contribution is in memory or honor of:
Make checks payable to 				_______________________________________
Wakefield Foundation and mail to:		
						Please notify the following about this contribution.
Wakefield Foundation c/o Wachovia			Name: ________________________________
Charitable Services NC 6732				Address: _______________________________
100 North Main Street, Winston-Salem, NC 27150	City, State, Zip: __________________________

The Foundation is a 501 (c)(3) nonprofit organization. Donations are fully tax deductible.