Date __________

Please establish an automatic credit card monthly gift account for me.

My monthly donation amount of $____________ is to be credited to

THE LAZARUS PROJECT, source code # 8156.

I prefer to have my gift deducted on the 6^th ___ 15^th ___ 24^th ____

of each moth.

Credit Card name (Visa, MC, AmEx, etc.): _________________________________

Credit Card number ________________________ and ID Code_______________

Expiration date ____________

(I have made a copy of this application to keep in my records.)

Signature ________________________________ Donor Number _______________

(Will be assigned)

Print your Name and Address Here _________________________________________

______________________________________________________

Child’s Sponsorship # _______________________

Mail to:

Lazarus Project Sponsorship Coordinator

Darrell Pfeffer

3551 SW 23 St.

Delray Beach, FL 33445