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Membership Dues Form
Contact Information
Name
First Name
Last Name
Phone
*
Email
*
Verify Email
*
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Name Of Theresian Community
*
Covenant Commitment
Covenant Commitment Dues
*
$100
I would like to contribution to the Theresian Scholarship Fund
$100
$50
$25
$
Add 3% to my total amount to help cover the payment processing fees
