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Champion of Life Pledge and Donation Form
Contact Information
Name
*
First Name
Last Name
Please tell us how you would like to have this gift recognized
*
Example: "The Mark and Linda Jones Family"
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Donation Information
*
$10,000
-
One donation per year
$2,500
-
Four donations per year
$834
-
One donation each month
Frequency (informational only; please do not change)
Monthly
Quarterly
Yearly
Pledge End Date
(mm/dd/yyyy)
