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Name & Address of Person Making Payment

First Name*: Last Name*: Suffix:(MD, Sr., etc)
Address*:     Apt. No.:
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Daytime Telephone No.*:   -     Ext.:
Evening Telephone No.*:   -     Ext.:
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Donations

$500 Sponsorship Donation - Be a major sponsor of an event and enrich the lives of children in foster care or at risk of abuse and neglect.
$250 Enrichment Opportunity - Sponsor a child's dream or nurture a special talent
GALA EVENT RESERVATIONS
How Many ? Gala Reservations - $85 per person ($75 before May 27)
How Many ? Raffle Tickets for St. Croix vacation - $5 each or 5 for $20  (You need not be present to win.)
$ Other Donation - Every dollar makes a difference for our most vulnerable children!
In Honor Of     In Memory Of    
$          TOTAL DONATION

Bank Information

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Bank Account Number:
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Select Checking or Savings Account: Checking     Savings

I understand that all contributions are tax deductible to the extent allowed by the law. The City of Alexandria adheres to state and federal privacy laws to protect customer information. All payment information will be treated as confidential, and will only be shared with third parties to the extent required to complete the transaction, to collect a debt, or as otherwise required by law. This transaction is also subject to the City of Alexandria's web site Legal Notices. For more information about the eChecks service, please contact the City of Alexandria Treasury Division, 301 King Street, Suite 1510, Alexandria, VA 22314, 703.838.4777, payments@alexandriava.gov.

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