Donate to AHSC Online

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Name*

First Last

Organization

Address*

Street Address City State ZIP Code

Phone*

Email*

Use My Gift as Follows (Select one)*

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Event Name and/or Date

If for Spiritual Direction, Please List Director's Name:

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If for Spiritual Direction, Please List Director's Name:

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If for Spiritual Direction, Please List Director's Name:

Donation Amount*

Credit Card

Discover

MasterCard

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Card Number

Expiration Date

Security Code Cardholder Name

Comments

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