Partner & Associate Partner Program: Commitment Form Partner & Associate Partner Program Commitment Form Please provide your contact information: Name * First Name * Last Main Phone Email * Note: Christ House will not sell, trade, or give your email address to anyone at any time. Do you wish to receive monthly e-newsletters from Christ House? Yes No/I am already on the email list Address * Note: Christ House will not sell, trade, or give your mailing address to anyone at any time. Apartment #, if necessary City * State * ALAKARAZCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Postal Code Remembrance Day We will display a certificate of appreciation with your name in the Christ House foyer on your Remembrance Day. You will also receive a letter with patient statistics from your Remembrance Day. Please choose: I will select a Remembrance Day Assign a Remembrance Day to me Date of Remembrance Day: Significance of my Remembrance Day: Financial Commitment Details I commit to donate: At the Partner Level: $3,000 or more this year At the Associate Partner Level: $1,500 - $2,999 this year Method: I will donate online or by mail.Please contact me to set up a monthly credit card donation.Other Method: If we haven't received your support by November 1, 2017, would you like to be reminded of your commitment? No, thank you Yes, please send me an email Yes, please call me Yes, please send me a reminder in the mail Would you like to be listed as an anonymous donor? Yes No Δ