Faith & Fifty Cents Renewal

I would like to become a monthly donor in the amount of
- $15
- $25
- $50
- $100
- Other
Amount
(if "Other" marked above)
Name*
Annonymous
- Check here if you prefer to remain Anonymous in the Honor Roll of Donors
Address*
City*
State*
Zip*
Home Phone
Work Phone
Cell Phone*
Email Address
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