Required Information First Name(s): (i.e. John and Jane) Last Name: Address Line 1: Address Line 2: City: State Zip
Home Phone: Work Phone:
E-mail Address:
Monthly Gift (Amount you'll give per month for 12 months) $
Day Sponsor 1 Check here to acknowledge your $120.00 gift Month January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2003 2004 Reason/Occasion:
Day Sponsor 2 Check here to acknowledge your second $120.00 gift Month January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2003 2004 Reason/Occasion:
Day Sponsor 3 Check here to acknowledge your third $120.00 gift Month January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2003 2004 Reason/Occasion:
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