23-24 Capital Campaign form

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Amount

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Other Amount

Other Amount

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USD

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Campaign

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Dedicate my donation in honor or in memory of someone

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Type

Honor

Memory

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Tribute Name

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I would like to send an acknowledgment to someone.

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Acknowledgee Name is the same as the Recipient.

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Your information

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This is a Payment on a Pledge

Yes

No

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First Name *

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Last Name *

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Submit as a company

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Name for Recognition

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Company Name

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Phone Number *

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Email *

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Address Line 1

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Address Line 2

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City

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State/Province

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Zip/Postal Code

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Country

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Payment Details

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Card

Cardholder First Name *

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Cardholder Last Name *

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Cardholder Email

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Card Number *

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Expiration (MM/YY) *

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CVV *

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Billing address is the same as mailing address

Address Line 1

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Address Line 2

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City

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State/Province

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Zip

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Country

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Amount:

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