2016 FORM #17
Imagine No Malaria Pledge Form
Instructions: Complete all information below, including the amounts already given and remaining to pledge.
Both the Pastor and Lay Leader should sign the form. Return a copy to the District Office by the date of the
charge conference, if not completed at previous year's charge.
STILL TO RAISE:
$
ALREADY GIVEN:
TOTAL CONTRIBUTION:
$
$
Church Name: ______________________________ District:__ _____________
Local Church Organizer:
Organizer Email:
Organizer Phone:
We,
, commit to the following:
Goal Amount:
Goal Length:
Save 5,000 lives / $50,000
Save 250 lives / $2,500
Save 1,000 lives / $10,000
Save 100 lives / $1,000
Save 500 lives / $5,000
Other: _____________
 1 years
 3 years
 Other: ___________________
Payments will be sent to:
California-Pacific Conference, PO Box 6006, Pasadena CA 91102-6006 with Imagine No Malaria in memo.
 Monthly
 Quarterly
 Annually
 Other ____________________
_________________________________
_______________________________
Pastor-in-Charge Signature
Lay Leader Signature
This goal will be fulfilled from the following sources (include amounts if applicable or known):
Church finances (budget, endowment, etc)
$________________________
Member support (individual gifts and pledges)
$________________________
To learn more about Imagine No Malaria in the California-Pacific
Conference and to request resources, contact:
Imagine No Malaria Field Coordinator
California-Pacific Conference
(626) 263-0175 // www.buzzkills.net
$10 saves a life. How many lives can you save? Text MALARIA CP to 27722 now to make a $10 donation.
www.ImagineNoMalaria.org
100% of all funds donated will support the programs and services of Imagine No Malaria.
All gifts are tax-deductible to the extent allowed by law.