Name:

Phone:

Address:

City:

State:

ZIP:

Email Address:

▢ Check/Money Order

▢ Credit Card

Amount: $

If paying by credit card, please check card type:

▢ Visa^®

▢ Mastercard^®

▢ Discover^®

▢ American Express^®

Credit Card #:

Expiration:

Name on Card:

CVV:

Event Name: 2025 Walk for Wishes - Statewide, IL

Participant Name: Ryan Norland

ID: 11212023

Team Name: Ryan's Super Crew

Please mail donations to:

Make-A-Wish® Michigan
1702 E. Highland Ave Suite 400
Phoenix, AZ 85016

Please mail donations for another chapter or Make-A-Wish America to:

Make-A-Wish America^®
1702 E. Highland Ave., Suite 400
Phoenix, AZ 85016