Membership Form

MEMBERSHIP FORM

A 501(c)3 non-profit organization
Full Name*

First NameLast Name
Phone Number*
Birthade

MonthDayYear
Date
E-mail*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Donation*

PLATINUM: From $130.00 and over.GOLD: From $75.00 to $129.00SILVER: $10.00 to $74.00
Amount

prevnext( X )
USDDescription

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Donation:

MonthlySemi-AnnualAnnual
Anonimous Donation

YesNo
Can we publish your name?

YesNo
We appreciante your monthly donation. Your noble attitude inures prosperity to you, your family and your business!
This agreement may be terminated at any time with(30) thirty-day notice by either party.
Signature

Clear
The LORD will send a blessing on your barns and on everything you put your hand to. The LORD your God will bless you in the land he is
giving you. Deuteronomy 28:8
Should be Empty:

MEMBERSHIP FORM