EUGENE & SHERRI DOMINGUEZ
Missionary
PERU

It is understood that this pledge of support will continue as long as this missionary remains under appointment or until we instruct otherwise.




Enrollee name (please print) ___________________________________________________________________

Mailing Address ___________________________________________________________________

 

___________________________________________________________________

City ______________________________ State/Province ______ Postal Code ____________

Email Address:___________________________

 

 

If enrollee is a church, signature of pastor _______________________________________

If enrollee is an individual, signature of individual _____________________________________

 

This is a new pledge effective ____/___/___.              Total monthly pledge amt :($50 suggested)

  

This is an increase effective ___/___/___.                   $______            $100           $50 

                                                                                    Other                $200           $75


          

-- FOR OFFICE USE ONLY –

                                                                         FUND  AC  GT   CLASS   U1   U2  U3  PROJ
                                                     PM Entry Code: 103 . fp . lp .  033115 . 11 . 1101 . 17222. 
 
 

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