Shipping Letter
the Medicine Box^® Program

Name of Church/Organization:______________________________________

Address:_______________________________________________________

City, State, Zip:__________________________________________________

From (Name of Project Coordinator):__________________________

Phone:_____________________ E-mail:___________________________

This is to advise you that we have sent _________ (number) Kit(s) to

I.M.A. on:________________ (Date Sent)

with (Name of Shipping Service):_____________________________________

   Please designate this Kit for inclusion in an I.M.A. Medicine Box^® for a member program of the following organization:

_________ The United Methodist Church
_________ Adventist Development and Relief Agency International
_________ American Baptist Churches U.S.A.
_________ Christian Church (Disciples of Christ)
_________ Church of the Brethren
_________ Church World Service & Witness, N.C.C.C.U.S.A.
_________ The Episcopal Church
_________ Lutheran World Relief
_________ Mennonite Central Committee
_________ Presbyterian Church (U.S.A.)
_________ United Church of Christ
_________ Vellore Hospital, India
_________ Use Where Needed

   You may prefer to use our graphic version (25K), a reproduction of the form in the printed packet.