Name: __________________________________________________________________ Mr/Mrs/Ms/Dr First Name Last Name or Company Name Address:____________________________________City:_________________________ State:____________Zip Code:___________Email:_______________________________ Gift Information (check one on each line) I would like to make a tax-deductible donation(s) of: _$25 _$50 _$100 _Other Amount $_____ Contribution Type: _One Time _Monthly _Quarterly _Annually Payment Options _My one time contribution check to Opening Gates, Inc. is enclosed _My monthly contribution check to Opening Gates, Inc. is enclosed Would you like
a monthly email reminder: _Yes _No Please complete this form and return it (with
check) to: Opening Gates, Inc. 5006 Charlestown Pike, *If 100 people give $10 per month, we will reach
our goal of $12,000 in 12 months. *If 100 people give $20 per month, we will reach our goal of $12,000 in 6 months. |