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Name: Email: Address: Zip: Daytime Phone: Select ONE or COMBINATION of organization(s) by writing a dollar amount next to the name of the organization(s). (Minimum gift/ organization: $25; Maximum
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To fill out the name field, enter your first and last name.
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To fill out the email address field, enter your valid email address.
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To fill out the zip field, enter your area zip code.

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Name, email address, and zip code are personal identifying information.
Individuals or entities collecting personal information may be required to file name, email address, and zip code.
Simply provide your name, email address, and zip code in the designated fields.
The purpose is to accurately identify and contact individuals or entities.
Name, email address, and zip code must be reported.
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