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2. This donation is being made by:

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4. Contanct Person's First Name

5. Last Name

7. Name of Business (if applicable)

9. Address1

11. Address2

13. City

14. State

15. Zip

17. Email Address

18. Phone Number

20. Donation Amount

21. Payment Method

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23. What name should be listed as the doner?

25. We sincerely thank you for your donation. We will followup with a letter for your records. Next, you will be taken to PayPal to process your donation.

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