Yes! I would like to participate in the Flag promotion this year.  

The cost is $10 per displayed flag.

Personalized flags to be displayed at the Wiley Retirement Community from June 14th through July 4th. The flags will be 12" x 18" with a personalized yellow ribbon attached.

Payment can be made by cash, check or credit card to the "Wiley Home Auxiliary."  Please complete the form below and indicate which form of payment you prefer.  

Cash and check can be mailed to: Wiley Home Auxiliary, 99 East Main Street, Marlton, NJ 08053
or
dropped off at the Wiley Reception desk at the Main Entrance.

Please click HERE for Credit card payments. 

Donor Name:

Street:

City/State:

Zip Code:

Phone Number:

How would you like to pay?

Choose... Cash- Mail to address above Check- Mail to address above Credit Card- see Link above

Total Amount Due $

Name on the Ribbon:

Please pick one:

• In Honor Of

• In Memory Of

Would you like to order an additional flag?

• Yes

• No

If you would like any additional flag entries, please comment name and "in honor of" or "in memory of" below.

Would you like to be added to our email list for updates on upcoming Wiley Mission events?

Choose... Yes No

Email:

Any additional comments or questions: