Charity Donation Form

Contact Information

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* 1. Name:

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* 2. Email:

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* 3. Phone:

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* 4. Address:

Donation Information

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* 5. Donation amount:

$0

$500

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 6. Do you want to make your donation anonymously?

Yes

No

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