"In Memory of" Donation Form

Gift amount

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Full Name

First NameLast Name
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail for receipt:
Do you want BTCP to send an acknowledgment of your gift?

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Acknowledgement

Please provide the information for who should receive the acknowledgment.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

"In Memory of..." Donation Form