Privacy Info Request Form

Privacy Info Request Form

Please fill in all the fields below, print the form and then fax or mail it to us.

If you wish to return this form by fax:
Fax: 316-269-0665
Attn: CEO/Executive Director

If you wish to return this form by mail:
Ronald McDonald House Charities Wichita
Attn: CEO/Executive Director
1110 N Emporia
Wichita, KS 67214

First Name *

Last Name: *

Address: *

City, State

Zip Code:

Email:

Request:
Please delete my personal informationPlease discontinue further use of my personal informationPlease provide me with all the personal information you have collected

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By signing this form, I attest to the fact that I am the individual named above.

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