Postal Mail Order Form        Print this page. Send your donation to  The Life Center   . Make your check or money order payable to The Life Center  Mail to: Robert Cote' The Life Center   11589 La Grange Rd. Jamestown CA  95327                                           Please print Clearly Your Name:_______________________________________________ Mailing Address:___________________________________________ City:_____________________ State:__________  Zip:___________ E-mail Address:  __________________________________________ Phone Number:  ___________________________________________ Whom do you know that we should contact regarding our work? Their Name:______________________________________________ Mailing Address: __________________________________________ City:_____________________ State:___________ Zip:__________ Their E-mail Address: ______________________________________ Can we say that you referred them to us  _____ YES  _____ NO. . Please share your thoughts and opinions with us. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________