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Your Name:*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Your Telephone:*
Your Email Address:*
Is this gift a tribute donation in honor or in memory of someone?*
- Yes
- No
This is a gift:
- In memory of
- In honor of
Would you like this gift to be anonymous?
- Yes
- No
Name of pet or person:

Memoriams and honorariums are printed in the WAIFarer newsletter.
Would you like us to send a gift acknowledgement?
- Yes
- No
Acknowledgement Name:
First Last
Acknowledgement Address:
Street Address City State ZIP Code

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