YourStory International · Advocate Payment

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Your Contact Information

Please complete the following form to submit the donation amounts required to fund your trip. This form can be completed either by the Advocate or on their behalf. All donations are eligible for federal income tax deduction. All donations are considered final and non-refundable.

Name

First Name

Last Name

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Address

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Address Line 2

City

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ZIP/Postal Code

Country

Payment

$240

$455

$365 (Haitian-American Scholarship Recipients)

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