Donor No.(if known): ______________

Name: ______________________________________________________

Address: ____________________________________________________

____________________________________________________________

City: ________________________ State/Province: __________________

Zip Code: ____________________ Country: ________________________

   I want to receive the MEANS newsletter.
   I want to know more about the ministries MEANS supports.
   I will pray for MEANS and the ministries in East Asia.
   I am interested in volunteering. Please contact me.

Telephone: (_____)_____-________________ Work  Home  Cell

Email: ________________________________

Feedback: ____________________________________________________

How did you find us? ____________________________________________

Check No.            Check Date                                    Check Amount

_________            __________                                   ____________

_________            __________                                   ____________

Please send my tax-deductible love/gift(s) to:

Recipient Code             Name Of Mission                                Amount
(if known)       

R__________     ____________________________        ___________

R__________     ____________________________        ___________

R__________     ____________________________        ___________

R__________     ____________________________        ___________

R__________     ____________________________        ___________

Special Instructions: (Help us process your donation accordingly by filling out
as much information as possible)

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Note:
Please make your checks payable to "MEANS". 6% of your total gift will go to MEANS
operational expenses.