Ongoing Donor Participation Card

Wings World Wide
The Air Medical Foundation
11411 160th Ct. NE
Redmond, WA 98052

Name ______________________________________________________

Mailing Address ______________________________________________

City ________________________ State _____________ ZIP __________

Phone # ( ____) - ________________

E-mail _____________@____________. _______

Monthly Donation Amount (circle one) $15, $20, $35, $50
or $ ___________

Checking Account # ____________________________
(Please attach a voided check)

Name of Bank ____________________________

Bank Branch ____________________________

Bank Address ____________________________

City __________________ State ________ ZIP _________

Please bill my checking account monthly. I understand that my donation will go to the operation of Wings World Wide - The Air Medical Foundation and its medical mission. I authorize my bank to issue a monthly check payment to Wings World Wide - The Air Medical Foundation as indicated above. I also understand that I may cancel my “ongoing” donation at anytime by notifying the Foundation thirty (30) days prior to cancellation.

Signature: ______________________ Date:______________