Donor Information

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* 1. Donor Name

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* 2. Donor Address

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* 3. Donation Amount

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* 4. Reason

In Memory Of

In Honor Of

General Donation

Teal Power 5K

Jeans & Jewels Gala

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* 5. In Memory/Honor Of

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* 6. Please send acknowledgement to (Name & Address)

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* 7. I would like to remain anonymous

Yes

No