Please print this form and mail to GNN along with your donation.           GNN ID # 215

  Personal Information

Last Name __________________ First Name_______________ Middle Int._____

Street______________________________ City_________________

State____________________________ Zip_____________

Phone_____________________              Station Call Letters _________ (Listed on Home Page)

   Method of Payment

Personal Check   Cash     Credit Card(VISA/MC)     Add/Change Donation                                                           Call 800-926-4669 to give via credit card

         Direct Giving Plan      (One Step Donation allows you to participate in the Good News Network automatic fund transfer plan.  My blank, voided check is enclosed.  Please deduct the amount indicated each month on the day shown.  This authorization will be the same as if I had personally signed a check.  It will remain in effect until I notify the Good News Network that I wish to discontinue contributions.)

Gift Amount $ ________ to be transferred on the    3rd    or    18th  (circle one).  Deductions should begin each month beginning  ______________ (show date)

                 Signature: (Required for Direct Giving Plan)  _________________________

 * Please attach voided check or deposit slip.
 * You will continue to receive monthly notification from us regarding your contribution.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

What type of pledge:             Monthy                           Change Donation Amount        

            One time donation                                            Amount   $ _________________

GNN  Home