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ROGALLO FOUNDATION MEMBERSHIP FORM
Please print out this form and mail it to us along with your tax free contribution.

Yes! I want to help protect and preserve the legacy of free flight.

My Special Gift is: [ ] $25 [ ] $50 [ ] $100 [ ] $500 [ ] $1,000 [ ] $2,000
Name __________________________________________
Address __________________________________________
State __________________________________________
Zip Code __________________________________________
Country __________________________________________
[ ] Master Card [ ] Visa # _____________________________ Expiration Date _______
Signature: __________________________

Please Mail to:

The Rogallo Foundation
P. O. Box 1839
Nags Head, North Carolina 27959-1839
252-441-4124
John Harris, President