ASSIST Bridge of Friendship - China  Sign-up Form
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A donation of $16.00 will help cover the cost of the program.
Please complete the following form, print it for your records, and mail it to ASSIST Ministries.
 

First Name:  
 Last Name:
 E-mail Address:
Mailing Address:

 City:  
 State:
Telephone Number:
 Zip/Postal Code:
Country/Province:
 Your church affiliation:
Do You Speak Chinese? If yes, what dialect?
Interests:
Status:
Single;  Married;  Divorced Prefer to not State; Gender:  M   F  Age:
Bridge of Friendship requires a commitment on your behalf to continue the friendship with your pen pal.  Are you willing to make that commitment? Yes;  No
I will send in my suggested donation in US funds of $16.00:  Yes; No
I will send in an additional donation to ASSIST Ministries; 
   (If yes, please state amount): US$
    Total amount of donation is: US$
If you wish to pay by credit card, please submit this form and use our secured system on the next page.
If you wish to mail in a donation, please submit this form, print the next page, and enclose it with your donation:

Checks should be made payable to:

ASSIST Ministries
PO Box 609
Lake Forest, CA  92609-0609
USA

As an anti-spam measure,
please type ASSIST in this field:
before pressing Submit