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Please make check payable to Reconciliation Outreach. Please charge my credit card in the amount of. Return original with payment enclosed no later than October 3 2017. Please include a list of guest names. Visa MC American Express Name as it appears on card Card Number Expiration Date CVC Code Signature Date Please keep a copy for your records. Please seat me with. NOTE Individual ticket purchases are not listed in program. I am unable to attend. Please accept my donation in the amount of....
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