Association of the Miraculous Medal
Perryville, Missouri 63775 USA

CONTRIBUTION FORM

Your contributions help the work of the Association (promoting devotion to the Virgin Mary, especially as our Lady of the Miraculous Medal, and supporting the ministries of the Congregation of the Mission in the Western Province). When so designated, your contribution can also support the Vincentian worldwide missions.

Dear Father,

I would like to give a gift to the Association of the Miraculous Medal.
$25       $50    $100     $

    Please designate my contribution to support the Vincentian missionary priests
and brothers for their work among the poor.

Title:   Other:  IDO7
Name
Address Apt.
City
State:   Zip
Phone Number
Email Address

Are you on our mailing list? Yes No
If so, it would be helpful to give us the 9-digit number at the top of your mailing label

For your convenience we accept Visa, Discover, MasterCard, and American Express.
Card Number
Expiration Total Charge $
Name on card

Signature ____________________________

After you print this page, sign it and mail it along with your donation to:

Association of the Miraculous Medal
1811 West Saint Joseph Street
Perryville, MO 63775 USA

or fax it to the Association at 1-573-547-1389