Todays Date ____________________
Gateway of Hope House of Restoration
Membership Application

Company_____________________________________________________________________________
Address_______________________________________________________________________________
City/ST____________________________________
E-mail____________________________________
Phone__________________________________
All your personal information is kept confidential
Chose One

Founder
Co-Found
Partner
Supporter
Friend
Heartfelt

I will make a commitment of...

One year                        Two years
Three years                     Four years
Five years              Six years
Seven years                      Eight years
Nine years                    Ten years
To: P.O. Box 175, Buchanan, NY, 10548
Circle One
I will donate once a...

Mounth

Year

I will give a one time Gift
Name________________________________________________________________________________
Zip/postal code___________________________
Date of Commitment will begin ____________________
Founder - $2000.00  or More  Par-year    or    Monthly

As a Founder your name will be placed in a gold plack within the House of Restoration. You will receive updates on our financial status as will as letting you know how your gift is being used. You will also be invited to spend four weekends out of the year at the house; you will also receive invitations to special occasions. You will also be able to vist the House at your convenience.
Partner - $400.00 - $500.00  Per-year  or  Monthly

As a Partner your name will be placed on bronze placks within the House of Restoration. You will receive a yearlly update on our financial status. You will also be invited to lunch three times a year and receive invitations to special occasions.
Co-founder - $1000.00  Per- year  or  Monthly

As a Co-founder your name will be placed on a silver plack within the House of Restoration. You will receive updates on our financial status and updates to where your gift is being used. You will also be invited to lunch four times a year and one weekend stay at the house; and receive invitations to special occasions.
Supporter - $200.00 to $300.00 Per-year  or  Monthly

As a Supporter you will receive a yearlly update on our financial status and our newsletter. You will also be invited to lunch at the house two times a year as will as invitations to special occasions.
Friend - $50.00 to $100.00  Per-year  or  Monthly

As A Friend you will receive a yearlly update on our financial statuse and our newsletter. You will also be invited to lunch at the house once a year and an invitation to one of our special occasions.
Heart-felt - $10.00 to $40.00  Per-year  or  Monthly

As a Heart felt member you will receive updates on our financial status and our newsletter. You will also recieve an invitation to lunch at the house.

Become a part of Gateway of Hope House of Restoration

I understand that my gift is not Tax Deductible at this time
One Time Gift

You can also give a one time gift to help us set our foundation towards the House of Restoration. If you wish to become a member continue reading below.

I understand that my gift is not tax deductable at this time.
I understand that I will receive the pribleges stated within the chosen doners title.
I have enclosed a check or money order payable to Gateway of Hope House of Restoration
I Understand and I still wish to give my gift at this time.