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Please SelectISEE41Dollar DonationGeneral Donation Invalid Input

First Name(*)

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Last Name(*)

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Email(*)

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Phone(*)

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Organization

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Number of Tickets

Please Select1 - $175.002 - $350.003 - $525.004 - $700.005 - $875.006 - $1,050.007 - $1,225.008 - $1,400.009 - $1,575.0010 - $1,750.00 Invalid Input

Sponsorship Level

Please SelectTitle - $50,000.00Platinum - $25,000.00VIP - $10,000.00Pal - $5,000.00Blindfold Sponsor - $15,000.00Photobooth Sponsor - $15,000.003D Printer Sponsor - $50,000.00 Invalid Input

Donation Amount

Please Select Your Donation Amount25 Glasses - $25.0050 Glasses - $50.0075 Glasses - $75.00100 Glasses - $100.00250 Glasses - $250.00500 Glasses - $500.001000 Glasses - $1,000.00Other Invalid Input

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Total

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