General Impact Fund - Annual Campaign
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Name

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Recognition Name (If you do not wish to be listed, please enter "Anonymous.")

I wish to be considered part of the Second Century Club (minimum $2,000 gift from a company or minimum $200 gift from an individual)

Are you giving toward your company's Annual Campaign?

Yes

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Is this gift in memory of or in honor of someone?

Yes, this gift is in memory of the following person.

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Yes, this gift is in honor of the following person.

* In honor of:

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Additional information or instructions regarding this gift:

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