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Capital Campaign Payment Pledge Form
Contact Information
*

Prefix
First Name
Last Name
Suffix

Prefix
First Name
Last Name
Suffix
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

for individual listed above in "name"
*

email for individual listed in "name" above
Count on me as a supporter of Ma'ayanot's Capital Campaign! I would like to donate at the level indicated below. I understand that the total amount of my gift can be paid over a multi-year period.
$


(mm/dd/yyyy)