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Amount
*
$1,000
-
one time/annual
$83.65
-
monthly
$38.50
-
bi-weekly
$19.25
-
weekly
Donation Schedule
One Time
Monthly
Annually
Weekly
Bi-Weekly
Contact Information
Name
First Name
Last Name
Email
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
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