International Partnerships Enrollment Form
Note: This form utilizes a security code image to prevent spam that cannot be read by screen readers. If you are visually impaired, please call 1-800-876-9880 or e-mail us. We apologize for the inconvenience.
Individual or Family Enrollment |
Congregation/Church Group/LLL Area Enrollment |
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* Name
or Group Contact Person: |
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Group Name: |
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* Address: |
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* City: |
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* State: |
* Zip:
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* Phone Number: |
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Fax Number: |
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* E-mail: |
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* The ministry center we would like to support is:
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* At this time, we would like to support our ministry center through:
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The amount of support we have chosen to commit is $
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If "Ongoing Financial Support" is chosen above, how often?
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Annual
Gift |
Quarterly
Gift |
Monthly
Gift |
$120
- $1,200 |
$30
- $300 |
$10
- $100 |
$1,200
- $3,600 |
$300
- $900 |
$100
- $300 |
$3,600
- $10,000 |
$900
- $2,500 |
$300
- $833 |
$10,000
- $20,000 |
$2,500
- $5,000 |
$833
- $1,667 |
Over
$20,000 |
$5,000+ |
$1,667+ |
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Additional Comments |
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Enter Security Code:
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