Pledge Form

Please make  blank copies to share with others, then fill out and sign the forms below,

keep a record, and forward completed form to our offices.

Once each year    I _____________  cheerfully pledge
please sign your full name above

to donate a ONE ($1.00 bill) to my Wabash Valley K.I.S.S.©  LIPS CHALLENGE,

thus showing my FAITH in our community's

" K.I.S.S.© lip wearin' fun "

 We sincerely believe that  masses can be motivated overnight

toward healthier lifestyles........simply by: All of us....

Wearin'  our K.I.S.S. LIP ©  Creations everywhere we go.......24-7-21 ........thus:

reminding each other  to assess and correct our

postures & deeper  breathin' skills

( foundations   for  Optimal  Health)

 lets let the spirit of gracious giving not be just once a year

365 ....... keep it alive

For an additional $2 ($3 total), and a self addressed stamped envelope, you will receive:

   1. Pair of Red Laminated lips

   2. Two moving eyes

   3. One pin clasp (to attach to clothes).  assembly required.

   4. One K.I.S.S.© LIP TIP booklet

                        ___ Student ___ Employed ___ Retired ___ Other

Name: _____________________________________________________
Last four digits of Soc Sec#_____________________________________
Address: ___________________________________________________
City/State/Zip: _______________________________________________
Day Phone: _________________________________________________
Evening Phone: ______________________________________________
E-mail address_______________________________________________
Special skills willing to share______________________________________

I believe it can happen! yearly pledge of    $     1.00

additional PACKAGE described above           2.00

Because I care even more DONATION   $______________
                    TOTAL   $
Mail pledge to:

K.I.S.S ©  THEORY LAND, Care of : KANDY  K.I.S.S.©  LIPS,  2200 N. 14th Street,  Terre Haute, IN 47804