
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.