Name                                                                                  

Church/Organization______________________

Address                                                                             

City/State/Zip                                           ______

Telephone                                                                       

Alternate Number                     _                         

E-mail                                                                   

_____Yes, I wish to help build spiritual and moral fiber through my gift of:

                $10.00                                  $25.00                 $52.00 (52nd Anniversary Donation)

                $75.00                                  $100.00    

                Other $