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FREE - Membership Application to Red Shoes World Ministry
3058 Driftwood Way, Suite 4405, Naples, FL  34109-8983 Phone 239-269-1171

Name *

Club Name 

(If you are part of a neighborhood club)

Address *

City *

State *

Zip Code *

Phone *

Email *

Fax

Signature *

Membership is FREE – If you would like to donate to Red Shoes World Ministry, Pleas fill in below.

Paid By Check	Check #		Donation Amount	$
Paid by Cash			Donation Amount	$
By Credit Card			Donation Amount	$
Circle Card Type Below
Visa	Master Card		Discover	American Express
Card Number
Exp. Date / Code	Month	Year	3 Digit Code
Email Address REQUIRED for All Credit Card Processing:
Credit Card Signature:
If Credit Card billing name and address is not same as above please fill in below for credit card payment.
Billing Name:
Billing Address:
Billing City, ST, Zip: