Partnership for Pastoral Counseling
PO Box 8177
Asheville, NC 28814

I/We would like to sponsor clients to have the ability to become healthier individuals, families and members of our communities.  Please accept our gift supporting pastoral counseling services in WNC. 

__$25      __$50       __$100       __$200       __$250 

__$500     __$750   __$1,000    $_____ Other

Please list our/my name as ___________________________________________

My information:

Name:      ____________________________________________________________

Address:  ____________________________________________________________

City:        _______________________________     State _______     Zip   _________

E-mail :    ___________________________________________________________

Telephone: __________________________________________________________

___Please add us to your mailing list for future communications and events of the Partnership for Pastoral Counseling.

Please make checks payable to: The Partnership for Pastoral Counseling

Please charge my Credit Card: ___VISA   ___MC   ___Discover   ___American Express

Name on Card:____________________________________________________________

Address - associated with card:________________________________________________

________________________________________________________________________

________________________________________________________________________

Credit Card #:__________-__________-__________-__________    

Expiration Date:_____/______

Gift Amount to be charged to Credit Card:$_______________

I authorize the Partnership for Pastoral Counseling to charge the above listed credit card for the amount listed above one time:______________________________________________________________________

                                                                Signature REQUIRED