Please review your donation details:
Submission Date: 12/14/2024
Name: {Name (First):2.3} {Name (Last):2.6}
Address: {Address (Street Address):3.1} {Address (Address Line 2):3.2}
City: {Address (City):3.3}
State/Province: {State:22}{Province/Territory:24}{Province/Region:25}
Postal Code: {Zip Code:23}{Postal Code:26}
Country: {Country:108}
Phone: {Phone:53}
Email: {Email:5}
What prompted you to renew: {What prompted you to renew?:14}
Name: {Gift Recipient Name (First):10.3} {Gift Recipient Name (Last):10.6}
Address: {Gift Recipient Address (Street Address):11.1} {Gift Recipient Address (Address Line 2):11.2}
City: {Gift Recipient Address (City):11.3}
State/Province: {Gift Recipient State:27}{Gift Recipient Province/Territory:29}{Gift Recipient Province/Region:30}
Postal Code: {Gift Recipient Zip Code:28}{Gift Recipient Postal Code:31}
Country: {Country:109}
Phone: {Phone:53}
Email: {Gift Recipient Email:12}
Member Number: {Member Number:102}
Donation:{Donation amount*: (All donations are charged in U.S. dollars) US G:71}
{Donation amount*: (All donations are charged in U.S. dollars) Int G:72}
Premium Requested: {Thank You Gift?:110}
Total Donation to be Charged: {Total:93}