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Fund Donation

ACTION for Healthy Communities Designated Fund

This fund supports the administrative expenses of the efforts of the ACTION for Healthy Communities collaborative.

Amount

Prefix

First Name

Last Name

Address 1

Address 2

City

State

Zip

Phone

Email

CC Type

CC Number

Expires

/

CC Security Number


More Information

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I would like to make my gift in honor of...

I would like to make my gift in memory of...

Please contact the following people and indicate I made a gift in their honor/memory. Be sure to include their address.


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