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Donate to the Elona Galperin Memorial Fund

Title
Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*
Phone Number

Area Code Phone Number
I want to give the Jewish students*

$180 $720 $360 $1000 $540 $1800

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Expiration Month	Expiration Year

Comments
Yes, I'd like to make this a monthly recurring payment.
Monthly Recurring Gift Amount
Monthly Recurring Gift Start Date
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