JENNINGS RANDOLPH RECOGNITION PROJECT

Enrollment Form

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

Please list me/my organization as a supporter of the 
Jennings Randolph Recognition Project to memorialize 
his contributions and to strengthen the values that 
Randolph espoused in his public service to 
West Virginia, the nation, and the world.

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.

Please FAX your enrollment form to: (304) 622-8000

Or mail to: