YES! I want to help MPI (Miami Pastoral Institute), make a real difference
in the lives of people in need of pyscholgical evaluation. Enclosed, please
find my gift in the amount of $_________(U.S. dollars, please)
Mr./Mrs./Ms./Dr. (please circle)
First Name:____________________________________
Last Name:____________________________________
Address Line 1:_________________________________
Address Line 2:_________________________________
City:__________________________________________
State:_________________________________________
Zip Code:______________________________________
Phone: ______________________________________
E-Mail:________________________________________
__ Check Enclosed (payable to Miami Pastoral Institute)
__ Please charge my contribution using my:
__MasterCard __Visa __American Express __Discover
_________________________________________ Credit Card Number
__________________ Expiration Date
___________________________________________
Signature
___Please check here if a friend or family member has need of evaluation
Copy the above and paste this form into E-mail or
print this form and mail it with your contribution to:
Miami Pastoral Institute
Attn: Donor Development Dept.
8180N.W. 155th Street, Suite 200
Miami Lakes, Florida 33016-3104
If you have any questions please send an E-mail