Interfaith Prayer & Reflection Services
             ~ DONATION FORM ~

YES, we wish to support the monthly Interfaith Prayer and
Reflection Services happening on the 11th of each month.

Please print out and mail in.

 
CONTACT NAME: _____________________________________
 
ADDRESS: __________________________________________
 
CITY, ST, ZIP: ________________________________________
 
PHONE(s): __________________________________________
 
EMAIL: ______________________________________________
 
 
BE A SPONSOR AT THE $300 LEVEL OR MORE *
BE A DONOR AT THE $120 LEVEL OR MORE *
We value any amount you wish to give to support our services.
 
          Please make your checks out to
Interfaith Prayer Service International
and mail to IPSI, P.O. Box 3451, Eugene, Oregon 97403
(Contact us for information on arranging monthly automatic payments.)

*1)  For SPONSORS/DONORS at the $300 or $120 levels
please print your NAME AS YOU WOULD LIKE IT TO BE LISTED:

 
NAME:____________________________________________________________
 
 
*2)  For SPONSORS/DONORS at the $300 or $120 levels
please print your ORGANIZATION OR BUSINESS WEBSITE
AS YOU WOULD LIKE IT TO BE LISTED:
 
WEBSITE:_________________________________________________________
 
 
Interfaith Prayer Service International is a tax-exempt religious organization
registered in the state of Oregon and donations are tax deductible
to the full extent of the law. 
 
 
Thank you for your support.
 

Interfaith Prayer and Reflection Services

www.InterfaithPrayer.org

a program of Interfaith Prayer Service International
 
P.O. Box 3451 ~ Eugene, Oregon 97403