Please Print and Mail this form with a check payable to Meaningful Movements Inc to:

Meaningful Movements, Inc.
6 Godwin Plaza, PO BOX 294
Midland Park, NJ  07432

Yes!  I want to support Meaningful Movements for the 2010-2011 Program year

I have enclosed my donation of $ __________

Last Name:___________________  First Name:_____________

Phone:________________________________

Address:_______________________________

City:__________________________________

State:________________

Zip:_______________

E-Mail:_________________________________________