It is my/our intention to contribute $_________ (circle one)   Annually    Quarterly    Monthly

It is my/our intention to make the first payment in ___________________, 20____.

May we include your name, with amount, in our list of donors?    Yes      No 

Signature______________________________________________

Name (please print)______________________________________

 How would you like your gift listed on the gift wall/plaque/annual report? Please print 

Name__________________________________________________

 Address________________________________________________

 City_____________________________ State______ Zip _________

 Email________________________ Phone (______) _____________

Please make checks payable to

Bright Tomorrows CAC

409 Washington Avenue

Pocatello, Idaho 83201