Alternative
Gift Form
Alternative
Gift Form
Vitamins (One month supply of children’s Vitamin)
........for 15 children ..........
$22.50
........for 25 children .......... $37.50
........for 50 children ..........
$75.00
........for 100 children........
$150.00
$___________
Antibiotics
(average 7-10 day treatment costs $7.00)
5 people treated...........
$35.00
10 people treated.........
$70.00
15 people treated .........
$105.00
20 people treated .........
$140.00
$___________
Ibuprofen
(average treatment for 5 days costs $.50)
20 people treated............
$10.00
50 people treated...........
$25.00
100 people treated..........
$50.00
250 people treated .........
$125.00
$___________
Other Medicines or Supplies $_________
Total donation........................................... $_________
Your name: _________________________________________
(Please Print Clearly)
Mailing Address: PO
Box____________
State: ___________
Zip Code: ________
Street: _____________________________________
Phone: _____________________
Credit Card information:
M/C Visa
AmerX Discover
#__________________________________ Exp Date: _________
Mailing address for CFM: PO Box 18010, SLT, CA 96151
1. Print this page 2. Complete and mail with Credit card information or check made out to Church Family Missions