2020 Supporters

Application Form:
If you have an interest in the MWW Program, please email the following pertinent information to washington@mswheelchairamerica.org
___1. I would like to be a contestant
___2. I would like to nominate someone to be a contestant (send their information as well).
___3. I would like to be a financial sponsor or provide a donation.
___4. I would like the current MWW to come and speak at an event.
___5. I would like more information about this program.    
Name __________________________________  
Street Address __________________________________________________________
City __________________________________ State _____________ Zip ____________   Phone __________________________________  
Email __________________________________