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Payment Form

This form has been designed to handle donations, banquet sponsorships, banquet tickets and publication sales.   Please follow the instructions for each of these categories of payments.  If your payment is for more than one of these categories, please itemize the amounts paid for each in the comments section at the bottom of this form.
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Donation

* Mandatory fields
*First Name
ALL CAPS PLEASE - Example Format - JOHN
Middle Name
Middle Name or Initial
*Last Name
Example Format - SMITH
Company/Organization
Example Format - JOHN SMITH & COMPANY
Position Title
*Mailing Address
Example Format - 300 SPRING DR, STE 3
*City
Example Format - TUCSON
*State
Example Format - AZ
*Zip
Country
Example Format - MEXICO

Only fill in this box for addresses located outside of the United States.
*E-mail
Lower Case Please - Example Format - jsmith@aol.com
Work Phone
Use following format (888) 888-8888
Home Phone
Use following format (888) 888-8888
Cell Phone
Use following format (888) 888-8888
FAX
Use following format (888) 888-8888
*Total Amount ($USD)
Tabulate Totals from Each of the Selections Below.
Donation
Enter amount of donation.
Comments

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