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Membership/Donation Form
Contact Information
Household Member Name
First Name
Last Name
Additional Household Member Name
First Name
Last Name
Organization/Employer
Fill out if applicable to the donation
Email
Verify Email
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Phone
Amount
*
$1,000
-
Benefactor Level
$500
-
Guardian Level
$250
-
Steward Level
$100
-
Contributor Level
$50
-
Member Level
$20
-
Student level (age 24-)
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Weekly
Please add 3% to my total amount to help cover the payment processing fees