URBAN INITIATIVE VALEGRAMS

Thank you for purchasing a Valegram and supporting our Urban Initiative team. All funds will be used to support our students' ministry and outreach experiences.

Please understand that all purchases are final. If you have any questions please contact Kelley Funk, Assistant Director of Campus Life for Ministry & Outreach, at kfunk@westmont.edu.

STUDENT INFORMATION

Student First Name

Student Last Name

Dorm and Room Number: (Ex. Page 238)

Student email: (include @westmont.edu)

Message to Student (25 Character Max.):

YOUR INFORMATION

First Name

Last Name

Phone:

Email:

Mailing City:

Mailing Address:

Mailing State

Postal Code:

PAYMENT

Your Payment will be: $25 (includes long stemmed roses in a chic vase and gift box of chocolate and candy goods)

Name on Card:

Amount

Card Number:

Expiration Month

Expiration Year

Code:

Contact Information