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Membership Information
Annual Membership Levels
*
Friend ($35 - $49)
Participant ($50 - $74)
Patron ($75 - $249)
Promoter ($250 - $499)
Supporter ($500 - $999)
Benefactor ($1,000 - $3,499)
Champion ($3,500 and above)
Donation Amount
*
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Contact Information
This membership if from a business or individual.
*
Individual
Organization / Business
Business / Organization Name
*
Donor Name
*
First Name
Last Name
Email
*
Verify Email
*
Phone
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Is this a gift membership?
*
Yes
No
Gift Recipient Contact Information
Gift Recipient's Name
*
First Name
Last Name
Gift Recipient's Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Gift Recipient's Email
Verify Email
Gift Recipient's Phone
Additional Details
Comments / questions about this gift
Add 3% to my total amount to help cover the payment processing fees
