I/We pledge a total of $
     for the period of Jan 1, 2012 to Dec 31, 2012.

   Pledge will be paid:
      Weekly
      Semi-Monthly
      Monthly
      Quarterly
      One-time gift

   I/We would like to pay in the following manner:
      Preferred - By automatic deductions from my bank account.
           (Please complete Electronic Giving Authorization Form.)
      By check - no weekly envelopes needed.
      By cash or check using weekly envelopes. I/We would like pledge envelopes.
      Stocks or other securities (you will be contacted for further information).

I/We cannot pledge at this time, but will give as able.

Name(s): 

Address 1: 

Address 2: 

City:  State: 

Zip Code: 

Telephone: 

E-Mail: 


Please print this page for your records.