Donation Page

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Donation

* Mandatory fields
*Organization
*First name-
First & Last name should be related to the email address used for this profile
*Nick Name
Sue; Tom; Chuck; Liz; etc
*Last name-
First & Last name should be related to the email address used for this profile
Suffix
Jr., Esq., CLS, CLC, etc
*e-Mail
This is your LOGIN for this site and should BELONG to the person entered in the First/Last name fields
Street Address
Bldg Name/Apt./Suite
City
State
Zip
Phone
FL COUNTY- YOUR Office
We use this info to make sure you are invited to meetings held in your area
*I primarily work for:
in order to invite you to functions in your area, we need to KNOW the COUNTY where you work, and if your company has branches, which one relys on you the MOST.
I prefer Vegetarian Meals when I attend an event
If this field is not answered, we will "assume" you do not have a preference
*Amount ($USD)
Comment

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