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Print this form,
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and the At Work newsletter between issues of the magazine. |
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| Current Gift: $ _________ |
I plan to make this gift: __ monthly, __ quarterly, or __ other (__________) |
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$1000+ Vision 2010 |
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Donors over $100 in a year will receive an itemized statement the following January. |
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Name ___________________________________________________Address _________________________________________________City/State/Zip ____________________________________________Phone Number ____________________________________________MasterCard / VISA / Discover / American Express_________________________________________________Signature __________________________________ Exp Date _______ |
Total Contribution |