Sponsorship Application
 
First Name
Last Name
eMail*
Phone Number ()-
Address
City
State
Zip code
Country
Name of Child (N/A if no preference)
Sex
Boy Girl
No preference
Donation Amount

 
 
$25 Monthly $150 Semi-annually
$75 Quarterly $300 Annually
Other
Credit Card
American Express Mastercard
Discover Visa
Credit Card #
Expiration Date
Security Code
Name as it Appears on Card
Other Type of Payment
Checking Mail Payment 
Savings
Name of Bank
Routing #
Account #
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DVD
Comment Box
 
      
 P.O. Box 123
Berrien Springs, MI 49103
269-471-2629 Office
1-800-704-7611 Toll Free
269-815-5064 Fax
 

           
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A Registered 501(c)(3) Nonprofit Organization
 
 
 
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