Please print and mail.

Chalice Lighter Program Enrollment Form

Name: _________________________________________

Society: ________________________________________

Address: ________________________________________

City: _______________________________

State: _______ Zip: __________________

Phone: ___________________________

E-Mail: ________________________________________

I/we wish to support the denominational extension programs in our district by becoming SWUUC Chalice Lighter(s). I/we are making the following contribution of at least $10 for the current call and pledge to contribute to future calls (maximum of three calls per year. Enclosed is my contribution of $________________ (minimum $10) for the current call or $______________ (minimum $30) for all of the calls for the next twelve months. NOTE: include the whole family for a minimum of $25 per call.

Make check payable to SWUUC Chalice Lighters and mail to: Chalice Lighters, SWUUC District Office, 6720 Brentwood Stair Road, Ft. Worth, TX 76112