People for Life Donation Entry Form

TOTAL TRANSACTION AMOUNT $ ^{* required}

MEMBERSHIP DUES
The TOTAL TRANSACTION AMOUNT includes membership dues in the amount of $
Membership dues are $20 / family, $10 / individual, $5 / student, and $5.00 / senior citizen.

GENERAL DONATIONS
The TOTAL TRANSACTION AMOUNT includes a general donation in the amount of $

Please accept my donation in memory of

Please accept my donation in honor of

2011 MARCH FOR LIFE BUS TRIP
If the TOTAL TRANSACTION AMOUNT above includes reservations for the 2011 March for Life Bus Trip (Monday, January 24, 2011) ($40.00 per seat ) . . .

Name and phone number for seat 1:

Name and phone number for seat 2:

Name and phone number for seat 3:

Name and phone number for seat 4:

If you are paying for more than 4 bus seats, please convey the names and phone numbers in an e-mail or by calling 814-882-1333.

Please continue to the Secure Payment Form.
Then, fill in the "Billing Information" page. You may skip the "Shipping Information" page unless you have requested educational materials.

Contributions or gifts to People for Life, Inc. are not tax deductible.
The official registration and financial information of People for Life, Inc. may be obtained from the Pennsylvania
Department of State by calling toll free, within Pennsylvania, 1 (800) 732-0999. Registration does not imply endorsement.