1.	First Name:*

2.	Last Name:*

3.	Address Line 1:*

4.	Address Line 2:

5.	City, State and Zip:*

6.	E-mail address:*

7.	Home Church:*

8.	In response to God's guidance and believing in the importance of our conference-wide initiative, I commit the following three-year pledge:*

9.	This committment will be remitted as follows (please click on the checkbox for the time frame for payment of your pledge AND check the box next to "In the amount of:" and enter the amount you intend to remit in each time period):*
	Weekly    Monthly    Quarterly    Annually    In the amount of:

10.	Other schedule, pelase specify:

11.	Date pledge begins:*
	mm/dd/yyyy

12.	Please send me a Bank Draft Autorization form so I can make my payment automatically.*
	YesNo

13.	Special Notes About Gift: