Gateway Pregnancy Centers

34th. Annual Stewardship Banquet

Souvenir Journal Response Form

(see reverse side for ad sizes and rates)

Please return this form to Gateway with full payment

----------------------- cut here ---------------------
Ad copy or attach artwork (black and white only)
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Name: _______________________________________________________________________
__________
Business name: ________________________________________________________________

Address: _____________________________________________________________________

City: ______________________________________State:_________Zip:_________________

Phone: ( )___________________ Ad size desired: _____________________ (see reverse)

*** Total amount enclosed: $ ______________

”I am unable to place an ad but please accept my gift of $______________

Gateway Pregnancy Centers, Inc.

P.O. Box 1793, Union, NJ 07083 (908) 436-7515 e-mail: dean@gateway.org

*** Ad Prices follow