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___ I wish to donate $_________ (enter
amount)
______ My check is enclosed
___________ Please bill my credit card
MasterCard Visa Amex
(circle one)
Card number is: _________________________ Exp.
Date: __________
Cardholder Signature:
________________________________________
___ My company will match my gift. I
have enclosed the matching gift form.
Name:
__________________________________________________________
Address:
________________________________________________________
City: ________________________________ State: _________ Zip:
_________
Please make checks payable to MACH
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