Central Oregon Locavore
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Donation Form
Contact Information
Name
*
First Name
Last Name
Phone
*
Email
*
Organization
Company/farm/ranch name, if applicable
Amount
*
$1,000
$500
$350
$250
$100
$50
$25
$10
$
Donation Schedule
One Time
Monthly
Quarterly
Annually
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
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