MAIL IN DONATION FORM Copy (PDF)

Mail-in Donation Form
Avi Dobrusin
Wish-A-Mile® Participant Name____________________________________________
Yes! I would like to make a contribution to help Make-A-Wish® Michigan.
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$12,000
$6,000
$2,500
$1,000
$500
$250
$100
$50
$25

Adopt a wish, such as international travel or a Hawaii vacation
Adopt a wish, such as a destination shopping adventure
Help provide lodging for a vacation wish
Help provide airfare to an exciting wish destination
Help provide an excursion such as a helicopter ride or dolphin swim
Help provide a limo ride to a special destination
Help provide computer or gaming accessories
Help provide souvenirs for a vacation wish
Help provide an enhancement gift for a wish child

Please make your check payable to Make-A-Wish Michigan
Donor Name ______________________________________________________________
Address ___________________________________________________________________
City______________________________________________ State ___________________
Zip/ Postal Code_________________ Donor Phone ____________________________
Email _____________________________________________________________________
Thank you so much for your contribution! Please mail this form and your donation to:
Make-A-Wish® Michigan
Attn: 2016 Wish-A-Mile Bicycle Tour
7600 Grand River Ave, Suite 175
Brighton, MI 48114
800.622.9474 (phone)
Gifts made are a gift to the entire mission of Make-A-Wish® Michigan. The needs shown are symbolic of the common wish
elements associated with each wish and are only representative of our many wish-granting activities. Your gift will not actually
be used to purchase the item shown or to grant the wish described. Each symbolic gift is unrestricted and will be pooled with
other gifts to meet all of Make-A-Wish Michigan’s needs. The suggested donation amounts are based on average
estimated values.

Make-A-Wish Michigan grants wishes of children with life-threatening
medical conditions to enrich the human experience with hope, strength and joy.