Please print this form and mail to address below:
Membership and Ministry Program Support
(Please print clearly)
Name: ______________________________
Address: ____________________________
City/State/Zip: ________________________
Phone: (______)_______________________
Cell Phone: (______)___________________
E-mail: ______________________________
Church: _____________________________
Areas of Ministry Interest: _____________________________
Please select a membership level:
• ___ Benefactor: $500.00+
• ___ Patron: $250.00
• ___ Associate: $75.00
• ___ Basic: $50.00
• ___ Other amount $______
Ministry Program Support:
___ The Springs Retreat Scholarship - $250
___ Creative Seminar Underwriting - $150
___ Make Space for God Scholarships - $45
Return to be Encouraged Sponsorship:
____ Program Patron - $500
____ Scholarship - $250
Chapter Program Support:
____ Orange County - $100
____ Bakersfield- $100
____ Fresno - $100
____ Africa - $100
Other NEWIM Support $______
All contributions are tax deductible.
Payments can be made by check to NEWIM or by ___ Visa ___ MasterCard
Card Number: ______________________________
Exp. Date_________________________________
Please mail to:
NEWIM
P.O. Box 866
Balboa, CA 92661
If you have questions or need more information, please call (714) 318-4321
Thank you for your support!