Print and complete this form. Make your check payable to WakeUP Wake County. Mail this form and your check to: WakeUP Wake County, PO Box 6484, Raleigh NC 27628.
First: _____________________ MI: __________ Last: ___________________________
Address: _______________________________________________________________
City: ________________________________ State: ___________ Zip: ______________
Phone: ___________________ E-mail: _______________________________________
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