Patterned Language Support Form
Contribution Form

 1. Contact Information:
First                                                       Last



      State:    Zip Code:  

              Home (xxx-xxx-xxxx)                          Work (xxx-xxx-xxxx)                            Cell (xxx-xxx-xxxx)

              TTY (xxx-xxx-xxxx)                               VP (xxx-xxx-xxxx)



 2. Please specify your gift amount?
              Amount: $    (U.S. Funds Only)

 3. Please make your check to Patterned Language.   Mail this form and your donation check to the following address:

             Patterned Language Fund
             Gospel Ministries for the Deaf
             P.O. Box 21011
             Salem, OR  98686

  All contributions are tax deductable and a tax deductable receipt will be mailed to you.

  Thank you so much for your contribution, and may God richly bless you!