​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.



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Enrollee name (please print) ___________________________________________________________________

Mailing Address ___________________________________________________________________

 

___________________________________________________________________

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City ______________________________ State/Province ______ Postal Code ____________

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Email Address:___________________________

 

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If enrollee is a church, signature of pastor _______________________________________

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If enrollee is an individual, signature of individual _____________________________________

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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.