PINE LAKE CHRISTIAN CAMP

                                                                               SUPPORT PLAN

I would like to become a member of the Monthly Support Plan. I pledge my ongoing support to help provide a camping expeerience for our children in the amount: (please circle)

$10.00 per Month   $25.00 per month  $100.00 per month  Other_____________.

Name:                                                                                                     .

Address:                                                                                                  .

City/Town                                                                                               .

Method of Payment:(please circle)

    Twelve(12) post dated cheques     visa        mastercard

          Card Number:                                                                                 .

          Expiry Date:             /          .

          Signature:                                                                                        .

I understand that I may change or cancel my Pine lake Support Plan at any time.

I am unable to join the Plan at this time, but here is a single contribution of $               .

please send support info. to:

Pine Lake Christian Camp

Box 41 Pine Lake Ab.

T0M-1S0

all info will remind private and confidential