Amount Pledged $_____________

PLEASE PRINT THE FOLLOWING:

Payment Enclosed $____________

Name  _______________________________________

Address  _____________________________________

_____ payments of  $ ___________ Balance to be paid by June 20.

City/St/Zip  ____________________________________

Telephone  ____________________________________

_____ Please check if you wish your gift to remain anonymous

Email address  __________________________________

_____ I will pray for BCCHS

Year if BC/MHS Alum  ___________________________