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Please print this out and submit it with your contribution to
Courage.
Name:_________________________________________________________________ Address:_______________________________________________________________ Yes, Fr. Harvey, I support the mission and ministry of Courage. To help spread the word, I will give: (please check one) __ $1000.00 (or over) - The Terence Cardinal Cooke Circle __ $500 - $999 - Patron __ $250 - $499 - Benefactor __ $100 - $249 - Advocate __ $50 - $99 - Supporter __ $25 - $49 - Friend All names of donors will be listed according to gift category in a Tribute Booklet to be printed at the end of the year. If you do not wish your name to be printed, please check below: __ I do not wish to be named in the Tribute Booklet (I will be listed as "Anonymous" instead). Otherwise, please print how you would like your name to appear (i.e. John D. of Buffalo, NY):
Amount Enclosed (check one) __ I am enclosing the whole amount of my gift of $____________, OR __ I commit to giving _____installments of $______ each, for a total of $_______. Checks should be made payable to Courage and mailed along with this form to: Courage
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