YES! Count me in!! I want to help Save Lives & Souls 24 Hours A Day!!

Just print out and mail in this form with your donation. If you have Any questions please do not 
hesitate to contact us via:

phone: 772-219-1144

fax: 772-219-1198

email: lifecan@bellsouth.net

You will promptly receive a receipt in the mail, as all donations are tax deductible.

You will also receive a complimentary subscription to our very own Christian Action News!


Name ____________________________________ 

Address ____________________________________________

City ____________________ 

State ______ Zip ________ Phone ________________ Email _________________


Please make checks payable to LIFE, and mail to:
L.i.f.e. 5445 SW Woodham Street, Palm City, FL 34990

LIFE is a 501(c) 3 Non-Profit Organization approved by the IRS. Copy of the official registration 
& financial information may be obtained from the Florida Division of Consumer Services at 800-435-7352. 
Registration does not imply endorsement, approval or recommendation.