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* 1. Contact Information

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* 2. Are you over 21? (only for ordering wine, skip to next section)

Please make your selection(s) below:

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* 3. NOTE: The deadline for ordering wine has passed. Please skip to the next section.

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* 4. Being an event sponsor at:

If you are signing up for a sponsorship please don't forget to make a wine selection above!
Payment

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* 5. Credit Card Number

If you haven't yet, please don't forget to register HERE
You will receive a confirmation email, if you do not see it, please check your spam folder.

To request a copy of your commitment form or if you have any other questions by emailing Charlie Day at cday@samaritanministry.org
Thank you for Investing in Your Neighbor through Samaritan Ministry!
1516 Hamilton St NW, Washington DC 20011 - (202) 722-2280 - www.samaritanministry.org
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