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Amount
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$30
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$150
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$500
$1,000
$
Donation Schedule
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Contact Information
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Additional Information
Is this an Honorary or Memorial donation?
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No
Honorary
Memorial
Honorary Information
Honoree's Name
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Last Name
Honor Gift Type
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None
Anniversary
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Speedy Recovery
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Honor Gift Type - Other
Send acknowledgment to Honoree?
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No
Yes - by Email
Yes - by Mail
Honoree Recipient Name
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Last Name
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Address Line 1
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City
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Honoree Acknowledgement Email
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Memorial Information
Memorial Honoree's Name
First Name
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Send acknowledgment to Memorial family member?
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No
Yes - by Email
Yes - by Mail
Memorial Recipient Name
First Name
Last Name
Memorial Recipient Address
Address Line 1
Address Line 2
City
City
State
State/Province
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Memorial Acknowledgement Email
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I happily agree to cover the processing fee so that 100% of my donation supports Recovery Café Longmont.