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Year 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr date amount III. Additional Instructions How would you prefer your name be recognized Payment Options Credit Card Name as it appears on card Credit Card Number Payment Type Select One Visa MasterCard American Express Discover Expiration Date // Address Suite/Floor City State/Province Postal Code Country Payment by Check Please submit checks to CEIR Foundation 12700 Park Central Drive Suite 308 Dallas TX USA 75251 V. To the CEIR II. Enclosed find an...

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