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Donation Information
Amount:	$ 5,000.00 $ 2,500.00 $ 1,000.00 $ 500.00 $ 250.00 $ 100.00 $ 50.00 Other $     *
Designation:	Capital Campaign Annual Giving
Additional Information
Type of gift:	One-time gift Recurring gift
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Anonymous:	I prefer to make this donation anonymously
Comments:
Billing Information
Title:	Dr. Miss Mr. Mrs. Ms.
First name:		*
Last name:		*
Country:	Australia Canada New Zealand United Kingdom United States	*
Address lines:		*
City:		*
State:	<Please Select> AA AE AL AK AB AS AP AZ AR BC CA CZ CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MB MH MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND MP NT NS NU OH OK ON OR PW PA PE PR QC RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT	*
ZIP:		*
Phone:
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Payment Information
Payment Method:	Credit CardDirect Debit
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	Visa American Express Discover Maestro MasterCard	*
Valid From:	01 02 03 04 05 06 07 08 09 10 11 12  / 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017  (Maestro/Switch/Solo only)
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031	*
Issue Number:	(Maestro/Switch/Solo only)
Card Security Code:		*
	Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
Tribute Information
Type:	In Honor of In Memory of	*
Name:		*
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Last name:		*
	Mail a letter on my behalf	*