2019 Dana Campaign Pledge Form (online)
Flagstaff Insight Meditation Community (FIMC) - PO Box 3212 Flagstaff, AZ 86003 – http://flagstaffinsight.org

A community of spiritual practitioners committed to bring freedom and contentment to all beings without exception.

I/we pledge to support FIMC’s annual Dana campaign to cover operating expenses for 2019.

Name
Your answer
Address
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Phone
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E-mail
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Pledge
Total 2019 Pledge Amount
Your answer
Payment Frequency (fill out either A or B)
A: One time payment of _____ on planned date ____
Your answer
B: Monthly Installments of (for 11 Months)
Your answer
Planned Payment Method (check one)
Signature
Your answer
Date
MM
/
DD
/
YYYY
Thank you for your support of Flagstaff Insight Meditation Community
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