Summer Retreat Giving FORM

Please fill out the following information to give toward a student's summer retreat.

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number

For $100, I would like to sponsor a full week of camp for one student.

One week of camp

For $20 per day, I would like to sponsor the following number of camp days for one student:

Total:

Please enter the total amount of your donation and any notes about your contribution.

On the following page, you will be prompted to enter your credit card information via a secure Paypal site.