Response Card

Please respond and mail payment by May 8, 2015

Your Name (required)

Your Email (required)

Number of People Attending

If not attending, but donating to support the work of the Samaritan Counseling Centers (and formerly CMSF), please set the above to zero and enter the amount to be donated below.

Total Amount Being Submitted ($60/person)

Address

City

State

Zip Code

Phone

After you press Save, you you will be taken to PayPal. Then enter the amount of your donation.