JAMES WORMLEY 
RECOGNITION PROJECT

Enrollment Form

(There is no financial obligation associated with your participation.)

Please list me/my organization as a supporter of 
the James Wormley Recognition Project  (JWRP)
to memorialize his contributions to public service,
education, and entrepreneurship, his high ideals 
and devotion to humanity and civility.

Organization: ____________________________________________________________
Your Name: ____________________________________________________________
Title: ____________________________________________________________
Address: ____________________________________________________________
City/State/ZIP: ____________________________________________________________
____________________________________________________________
Telephone:

____________________________________________________________

Fax: ____________________________________________________________
E-mail: ____________________________________________________________
Signature: ____________________________________________________________

You will receive invitations to memorial events,
planning meetings and related activities.

The Agribusiness Council - JWRP
P.O. Box 5565
Washington DC 20016

Thank you!

"Building Bridges with Entrepreneurship,
Community Action and Humanitarian Spirit
"

Wormley Recognition

Contribution Form

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