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Please use this form for annual recurring pledge billed to you each year.
Donation Amount
Amount
*
$25
$50
$100
$250
$500
$1,000
$
Donation Schedule
Annually
Donor Information
Name
*
First Name
Last Name
Organization
Please list name here if donation is on behalf of an organization
Email
*
Your Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Phone
*
Notes
