BCYMP Mentoring Support Squad

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* 1. Please leave your contact information below:

Name *

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 2. Yes, I would like to join the BCYMP Mentoring Support Squad at this level:

Friend ($10/mo)

Encourager ($25/mo)

Uplifter (50/mo)

Champion ($100/mo)

Surpriser ($ other amount/mo)

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* 3. If you chose "Surpriser," do you know how much would you like to donate each month -- or would you like our Executive Director to contact you first?

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* 4. I will make my recurring donation this way.

I will set up a recurring donation to bcymentoring@gmail.com through Pay-Pal.

I will set up a recurring donation through MetaBank or First Bank & Trust in Brookings.

Please call me to set up a recurring donation via credit card.

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* 5. If you would like to set up a recurring donation via credit card and are comfortable sharing that information here, please add your number, expiration date, Billing Zip and 3-digit code in the text box below. Thank you!