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Donor Contact Form 2021
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First Name
Your answer
Middle initial
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email Address
Your answer
Phone/Cell (area code) _ _ _ - _ _ _ _
Your answer
highest level of education
Kindergarten - 8th grade
High School Diploma
College
Other
What Is Your Race
African American
Caucasian
Asian
Hispanic
Other:
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Would you consider a sponsorship or donation in the following manner (click all that apply)
Community Sponsor: $0 - $50
Corporate Sponsor: $51 - $100
Platinum Sponsor: $101 - $250
Silver Sponsor: $251 - $500
Gold Sponsor: $501 - $4,999
Angel Sponsor: $5,000 & Up
Other
Option 8
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