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  • Spina Bifida Donation Form

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    Gemma Smith
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    Gemma Smith is participating in the Walk-N-Roll DC 2011 event with the team Alex's Army to raise funds for the Spina Bifida Association. The document includes a donation form for contributors to provide their name, address, phone number, email, and donation amount to support Gemma's participation in the event through a financial contribution to the Spina Bifida Association.

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    Gemma Smith is participating in the Walk-N-Roll DC 2011 event with the team Alex's Army to raise funds for the Spina Bifida Association. The document includes a donation form for contributors to provide their name, address, phone number, email, and donation amount to support Gemma's participation in the event through a financial contribution to the Spina Bifida Association.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views1 page

    Spina Bifida Donation Form

    Uploaded by

    Gemma Smith
    Gemma Smith is participating in the Walk-N-Roll DC 2011 event with the team Alex's Army to raise funds for the Spina Bifida Association. The document includes a donation form for contributors to provide their name, address, phone number, email, and donation amount to support Gemma's participation in the event through a financial contribution to the Spina Bifida Association.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Support me as I participate in the Walk-N-Roll DC 2011.

    Participant's Name: Gemma Smith


    Team Name: Alex's Army

    Yes! I will make a contribution to help Spina Bifida Association.

    $500 $250 $100 $50 $25 Other Amt: ________

    Please Make Your Checks Payable to Spina Bifida Association

    Name ____________________________________________________________________

    Address __________________________________________________________________

    City______________________ State/Province__________

    Zip/Postal Code _________________

    Country__________________________

    Donor Phone________________________________________________

    Email _____________________________________________________

    Thank You So Much For Your Contribution!


    Mail this form and your check to:

    Spina Bifida Association of the Mid-Atlantic Region


    Attn: Mary Nethercutt
    4590 MacArthur Blvd., NW
    Suite 250
    Washington, DC 20007

    Additional Information
    This donation is in support of the 2011 DC Walk-N-Roll.

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