You are on page 1of 1

Yes, I wish to make a significant

difference at Banquet 2012!


_____ I plan to attend and will bring ______others with me. Please list your guests
names and addresses on the reverse side of this form.
______ I cannot attend, but wish to give a special stewardship gift of:
______$5,000 _____$2,000 ______$1,000 ____$500
______$20 per month pledge

______

___ $250 ______ other

$50 per month pledge

Name: _____________________________________________________________________
Address: ___________________________________________________________________
City ________________________________State_____________Zip___________________
Telephone: (

) ____________________email:_______________________________

Gateway Pregnancy Centers, Inc.

(973) 399-8378

960 Springfield Ave, Irvington, NJ 07111 Website: www.gateway.org dean@gateway.org

You might also like