Support USA Water Polo

Please print out, complete, and mail this form with your check or money order to:

USA Water Polo
2124 Main Street, Suite 210
Huntington Beach, CA 92648

Thank you for your support!

Name _________________________________________________________________

Street ________________________________________________________________

City ___________________________________ State _____ Zip ________________

Telephone ______________________

E-mail _________________________________
          (must have if electing to receive Donor E-Mail)

Amount Donated ________________________________________________________

Please check here if:

_____ You prefer not to be listed publicly as a USA Water Polo Supporter
_____ You prefer not to receive the bimonthly Donor E-Mail