PARC Task Force, Inc.

If you prefer, you can print out this form, complete and return it to:

PARC Task Force, Inc.
515 W. Moreland Boulevard, Room CG72
Waukesha, WI 53188
(262) 896-8026
(262) 786-8787 fax

Donor Application

Date:
Name:
Title/Affiliation:
Street Address:
City:	County:
State or Prov.:	Zip/Postal Code:
Country:
Email Address:
Telephone #: Ext.
Fax #:
Donation level
Please share how you or your family have been impacted by an alcohol-related crash:

In 1999...
38 % of the total traffic fatalities were alcohol-related. This is 1 fatality every 33 minutes.

Membership Application
Donor Application
Request for Information
Request for Presentation

Information listed on the PARC Task Force, Inc. website is believed to be current at the time of publication. However, some of the material presented here may have expired since it was posted. Persons should contact a PARC Task Force, Inc. representative whenever relying on dated material or information that is subject to change.