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Name
*
$
Dr.
Dr. and Mrs.
Miss
Mr.
Mrs.
Mr. and Mrs.
Ms.
Title
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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$
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Tickets
*
$
$
x $100.00
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Type in as many tickets as you require. Example, if you need three tickets, type in the number "3".
Donation
*
$
$
One Time
Recurring
If you cannot make it to our Annual Wine Tasting Fundraiser but still wish to donate. Remember, the Adult Day Center of Somerset County is a registered 501©(3) nonprofit organization, and all donations are tax-deductible to the extent allowed by law. Our Tax ID/EIN is 22-2111573.
Organization
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$
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Job Title
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$
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Note
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$
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