Southern Christian BLK Fundraiser Form

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First Name

Last Name

Company

Email Address

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

SPONSORSHIP LEVELS

Angel $25,000

Saint $15,000

Guardian $10,000

Protector $5,000

Mentor $2,500

Host $1,000

Hands of Providence Award $1,000

Tickets for (2) $250

Ticket for (1) $125

I cannot sponsor at this time, but would like to contribute a certain amount to assist with the needs of the agency.

I wish for contribution to remain anonymous.

My sponsorship and/or donation is given in honor of or loving memory of

Thank you for your support of our mission, Southern Christian Services for Children and Youth, Inc. serves and equips

vulnerable children and youth, assisting them in becoming self-sufficient and contributing members of society.

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