You are invited to join the MIKE Program Contributing Circle. Your pledge allows MIKE Program to make an investment in the health of our youth and our future as they train others in healthy behaviors. Please fill in the information below and click the button at the bottom to start your recurring contribution:

Amount and Frequency

Please indicate your place in the MIKE Program Contributing Circle: *

Student $10

Individual $35

Family $50

Friend $100

Sustainer $150

Steward $200

Patron $500

Benefactor $1000

Other

Please indicate your contribution frequency: *

Monthly

Quarterly

Annually

One Time

Contact Information

Name:

Address:

City/State/Zip:

Phone:

Email:

I wish to donate anonymously. (Your contact information will be withheld from our donor reports.)

Purpose

This donation is:

in memory of

in honor of

Name:

Notification

If there is anyone you would like MIKE Program to notify of your gift, please provide the information below:

Name:

Address:

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