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.

Please FAX your enrollment form to: (202) 887-9178

Or mail to: