Ralphs Community Contribution Program Registration Form

By registering and using your Ralphs Club Card at any Ralphs Store, the Mizell Senior Center benefits. Four times per year, Ralphs will send a check for 4% - 5% of the purchases made by those who have registered for the program.

To start earning for the Mizell Senior Center, complete this form today!

Name
Address
City
State
Zip
Phone
Email
Ralphs Club Card Number	Your Card Number is on the back side of your card under the UPC code

All responses to this form will be sent to Karen Kirby at the Mizell Senior Center.

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