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Ensuring Our Future Together Capital Campaign Gift

* Donor Name(s):

* Address of Donor

* City, State, Zip

* Donor Phone Number

This Donation is

	In Honor Of
	In Memory Of

Name

Send the acknowledgment to

Address

* Donation Amount $

*E-mail

*First Name

*Last Name

Account

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

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