Please pint this form, fill it out and mail/fax it to the address listed below.

 

Name/Name of Organization__________________________

Contact Person_____________________________________

Phone Number_______________________________________

Address____________________________________________

CHECK ONE

Total Donation Enclosed $___________________

Monthly Donation $__________________________

Time Period_________________________________

COMMITMENT PLAN (describe how your donation will be made including time period)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Total donation made or to be made $__________________________

Signature_____________________________________

Date____________________

Please print out this form and mail with your check to:

Robert L. Chalfa, Treasurer
P. O. Box 606 Bonita, CA
91908-0606

Tel: (619) 470-2885
Fax: (619) 267-4553
E-Mail robertchalfa@thousandsmiles.org

THANK YOU FOR YOUR GENEROSITY