Anna Marie's AlliancePeacekeepers Club

Membership Acceptance Form

Please print off this form and mail it to:

Anna Marie's Alliance

Fund Development

PO Box 367

St. Cloud, MN 56302-0367

Yes, I’ll join the Peacekeepers Club and support the ongoing work of Anna Marie’s Alliance

Monthly Donation

I’m proud to make a monthly commitment at the following level (choose one):

  Friend of Anna Marie’s $10-$25 monthly

  Change Agent $30-$50 monthly

  Advocate $55-$75 monthly

  Peacemaker Greater than $75 monthly

My monthly pledge amount is $______________.

Payment method (Choose one):

  Automatic Bank Transfer: I authorize CMTFBW to withdraw the amount indicated from my bank account on or about the 15th day of each month.

I have enclosed a voided check.

  Credit Card: I authorize CMTFBW to charge my monthly pledge amount on or about the 15th day of the month to:

VISA     Mastercard     Discover    American Express

Card No. _______________________________Expiration Date ________

Your guarantee: You may cancel your gift at any time.

Name: ___________________________________

Address __________________________________

City/State/Zip _______________________________

Phone (          ) ________________________

Email  _____________________________________

Thank you for becoming a Peacekeeper’s Club member!