A Campaign for Recovery
Breaking the Cycle of Addiction, One Life at a Time
Pledge Intention Form
I/We wish to support Lifeline Recovery Center with a gift of $_________.
Gift Designation (if applicable): ______________________________.
General Campaign Gift: ______________________________
I/We agree to make this gift as a:
One-time gift by (Month/Year) , Monthly recurring gift of
Multi-year pledge to be completed by December 31, 2026
Pledge Payment Amounts 2024 2025 2026
Method of Gift Payment (Please mark accordingly) ______ Check is enclosed ______ Credit Card (make gifts online at lifelinerecoverycenter.org/donate) ______ Stocks or other gifts (please email amiller@lifelinerecoverycenter.org for further details)
Donor Name:
City: ST: Zip:
Email: Cell:
Please print your names(s), organization or honoree exactly as it should appear, or simply write anonymous.
Donor Recognition Name:
Lifeline Recovery Center is a 501(c)(3) nonprofit organization. Tax ID: 20-0801622 A charitable tax receipt will be issued to acknowledge your generosity. All contributions will first be used for the Campaign. If fundraising support for the Campaign exceeds the Campaign funding need, Lifeline Recovery Center will allocate the overages to support ongoing operating costs.
Please return completed form to:
Lifeline Recovery Center amiller@lifelinerecoverycenter.org (or) P.O. Box 7652 Paducah, KY 42002