(Please print form and send to Harvest Time Assembly of God.)
                                                          Mail-in Form

Pastor Mullins,

I would like to become a Media Partner helping to spread the Gospel to the world. Enclosed is
my $25.00 Partner Fee or one-time gift/donation.

Please agree with me for the following need:

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Date _____________________

Name __________________________________________________________________

Address________________________________________________________________

_______________________________________________________________________

Phone: _________________________________

Monthly Gift of $_________________________One-time gift of $_________________

Mail to:
Harvest Time Assembly of God
634 Old Monticello Rd.
Somerset Ky. 42503
Church Phone: 606-678-3033

I would like to receive an Audio CD____________________ as my gift each month.