THE ANNA AND MONROE ALDERSON FAMILY HEALTH CLINIC

Thank you for your interest in supporting this new project of Project Brasil.
If you prefer, you can send a donation to:
PROJECT BRASIL • PO BOX 68 • HUMBOLDT, TN 38343

MONTHLY DONATION: I want to support the health clinic monthly

ONE TIME DONATION: I want to support the clinic with a one-time gift.

FIRST NAME

CHURCH/ORGANIZATION

CITY

PHONE

LAST NAME

ADDRESS

   
STATE            ZIP/POSTAL CODE

EMAIL ADDRESS

If you want to support the clinic with a monthly gift, please specify the amount you wish to donate each month.

$.00 MONTHLY

If this is a one-time gift,
please enter the amount here.   

$.00 One-time gift

 PLEASE CHOOSE A CARD TYPE
Visa  MasterCard Discover American Express

CARD NUMBER

EXP DATE (mm/yy)

Include any additional comments here.