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Name
*
$
First Name
Last Name
$
One Time
Recurring
Address
*
$
Address Line 1
Address Line 2
City
State
Zip
$
One Time
Recurring
Email
*
$
$
One Time
Recurring
DONATION INFORMATION
*
$
DONATION INFORMATION
$
One Time
Recurring
Donation Amount
*
$
$35
$70
$150
$300
$500
Other
$
One Time
Recurring
Weekly
Monthly
Yearly
This gift is given in memory of
*
$
$
One Time
Recurring
Will this gift be matched?
*
Yes
No
$
$
One Time
Recurring
Name the person or organization matching the gift
*
$
$
One Time
Recurring
Yes, I would like to cover the 3% processing fee