Name (Mr.)(Mrs.)(Ms.)______________________________________

Organization or Company_____________________________________

Address__________________________________________________

City________________________State____________Zip___________

Home Phone____________________Work Phone_________________

E-mail_____________________________

_____Enclosed is my check or money order made payable to Variety of Greater
          Kansas City in the amount of $____.($40 dues)

_____Please charge $________ to my credit card

Visa or Mastercard Number__________________Exp. Date___________

Cardholder's Signature_______________________________________

Please do not share my personal information (name and address) outside of Variety of Greater Kansas City .

_____Grant Allocations	_____Special Event Programming / Movie Premieres
_____Annual Gold Heart Sale	_____Oscar Night® America
_____Hy-Vee Golf Tournament	_____Children's Holiday Party

Thank you for your support!

Print the Form, Fill It Out, Mail It To::
Variety of Greater Kansas City
17 Anchor Drive
Lake Tapawingo, MO 64015-9650
ChiefBarker@VARIETYKC.ORG
(816) 220-2068