Frequent Flyer Miles Donation Form
Please fax or mail this completed form to:
Make-A-Wish Foundation of East Tennessee
510 South Willow Street
Chattanooga, TN  37404-3134
Phone: (423) 629-9474
Fax: (423) 622-5531

CONTACT INFORMATION
Full Name
Address
City, State and Zip
Home Phone
Secondary Phone
Email Address

FREQUENT FLYER MILE INFORMATION
Designated Airline
Mileage Account Number
Amount of Miles to be Donated (MINIMUM 5000)