Child Abuse Prevention Center

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40-400 Club
Member Form

Enrollment Information

Name:

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Company:

Address:

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City, State, Zip:

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Phone:

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Email:

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How did you hear about the 40-400 Club?

What motivated you to become involved with the Child Abuse Prevention Center?

Does your company offer an employee matching program?
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Donation Method

	Contribute $1,000 online now.
	Pledge to contribute $83.33 each month for 12 months and make the first payment online now. (Note the you will be invoiced each month via email for the remaining balance)
	I will arrange payment with Craig Strenger, Director of Development, via phone at (714) 955-6501 or by email at CStrenger@BrightFutures4Kids.org.

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