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Clip and Return with Check - THANK YOU!

21 E. Grand Avenue, P.O. Box 711, Chippewa Falls, WI 54729 Phone: (715) 720-9206

Yes, I would like to become a sponser of CFMIT. Please register me for the level that I have indicated.
I have enclosed a check in the amount of $__________________________

Individual Plan Level:
Level 1 Homesteader: household Level 4 Pathfinder
Level 1 Homesteader: Senior Level 5 heritage
Level 2 Explorer    
Level 3 Voyageur    

Business/Organization Level:
Level 1 Bronze Level 4 Platinum
Level 2 Silver Level 5 Patron
Level 3 Gold    

Name_______________________________________________________________
Bus./Org. Name (if applicable)___________________________________________
Street_______________________________________________________________
City______________________________ State______________Zip_____________
Phone (___)________________Email_____________________________________