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Organization
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Name
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First Name
Last Name
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Address
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Address Line 1
Address Line 2
City
State
Zip
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Email
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Phone
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Drop Down List
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1 Line Text - $35
1/4 Page Ad- $75
1/2 Page Ad- $150
Full Page Ad- $300
Presenting Sponsor- $1000
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Donation
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$35
$75
$150
$300
$1000
Other
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Note
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yes, I'd like to cover the 3.5% processing fee