Please accept my one time gift to support the ministries of Samaritan Outreach: __$500    __$250    __$100    __$50    __$25    Other________ You can count on me for: $____Monthly    $____Quarterly Name: _________________________________ Address: ______________________________ City: _________________________________ State: _________ Zip: _________________ May we include you on our mailing list? __________ Make checks payable to Samaritan Outreach and mail to: Samaritan Outreach P.O. Box 3842 Dayton OH 45401