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Programmes Girls High School

Donor Tanya Participation Form

First and Last Name:*
Email Address: *
Contact Number:*
Please write your dedication as you would like it printed (ideally in Hebrew):*
$18 is the minimum donation to have a name printed in the Tanya
What amount would you like to donate?
If selecting 'other' (above), please advise on amount:

Payment*

Credit Card

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Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Should be Empty:

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