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Amount
*
$20,000
-
Ambassador
$15,000
-
Champion
$10,000
-
Leader
$5,000
-
Guardian
$2,500
-
Partner
$1,000
-
Advocate
$500
-
Collaborator
$250
-
Supporter
$100
-
Friend
$
Donation Schedule
One Time
Monthly
Quarterly
Annually
Weekly
Bi-Weekly
Bi-Monthly
Continue donating until
(mm/dd/yyyy)
Contact Information
Sponsor Organization Name
*
Name
*
First Name
Last Name
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Add 3% to my total amount to help cover the payment processing fees