GRAPES SIGN UP FORM

Full Name

Address

Address - Second line

City                                          State         ZIP

Phone                                E-mail

 I would like to make a commitment to:

    GRAPES - General Operation Fund        for    $

    GRAPES - General Camp Staff Fund      for    $   

    GRAPES - Capital Improvement Fund    for    $

I am making a one time gift to:

    GRAPES - Capital Improvement Fund    for    $

Please send checks to:

Camp Witness

GRAPES PROGRAM

PO BOX 321

Long Pine, NE  69217

When you click submit, you will be taken to a page which will allow you to make an immediate

contribution to the fund(s) of your choice.  Because the camp does not employ a Web site expert,

the choices are somewhat limited.