This form has been designed so you can print it out
and complete it in privacy.

YES, I want to help . . . my name is:

Name____________________________________________
Address__________________________________________
City______________ State_________ Zip Code__________
Phone_____________ EMAIL________________________

Here is my gift of:
  $50  $100  $25   $500  $75   $1,000  $_____

 Cash (check or money order):

 Other:__________________________________________

 Please charge my credit card:

Card Number___________________________________
Expiration Date__________________________________
Signature______________________________________

 Other:__________________________________________

My Gift is made in memory, honor of: ________________
__________________________________________________

Please send an acknowledgement card to:
Name_________________________________________
Address________________________________________
City_________________ State_____ Zip Code_________

Please mail the completed form to:

Native American Ministries:  Arizona
c/o Arizona Conference of Seventh-day Adventists
PO Box 12340
Scottsdale, AZ 85267-2340