City Union Mission Bed & Bread Club Application for Membership

Name ________________________________________
Address ______________________________________
City/State/ZIP __________________________________
Phone (Daytime) ____________________ Phone (Evening) ____________________
E-mail _____________________________

____ I want to become a member of City Union Mission's Bed & Bread Club. I will send my pledge to feed, shelter and care for the needy in Kansas City.
( )I will send $15 or more monthly
( )I will send $45 or more quarterly
( )I will send $180 or more annually
( )Enclosed is my first pledge of $_______

____ I cannot become a member of the Bed & Bread Club at this time, but please use my special one-time gift of $_______ to help care for the homeless and hungry.

____ I would like to transfer a monthly gift of $_______ directly from my checking account.
"I hereby authorize City Union Mission to arrange an automatic transfer from my bank account on the 15th of each month."
NOTE: Please enclose a voided check to verify account information. Account must have check privileges.
Date transfer should begin: _____/_____
Signature _______________________________________ Date______________________

Gifts to City Union Mission are tax deductible.

Mail this form to:
City Union Mission
1100 E. 11th Street
Kansas City, MO 64106
Attention: Bookkeeping