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Company or Individual's Name
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Donor Name
Street Address Line
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State / Province
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Phone Number
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Please enter a valid phone number.
Partner Opportunities
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Diamond $50k
Emerald $20k
Ruby $15k
Platinum $10k
Gold $5k
Silver $2.5k
Payment Options
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Check Enclosed
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I/ We are unable to attend but would like to make the following contribution:
$1,000
$500
$250
$100
Other
Please utilize my donation for the following purpose:
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Operations
Scholarships
Black Business Equity Fund (BBEF)
Who is your Table Captain
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Contact same as above
Other (Complete Below)
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Email
example@example.com
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