AIDS Services of Dallas Online

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First Name:

Last Name:

Telephone:	- -

Address:


Donation Amount:	Friend ...	(Gifts - $99)
	Partner...	($100 - $249)
	Sponsor...	($250 - $499)
	Patron...	($500 - $999)
	Benefactor...	($1,000 - $2,499)
	Advocate...	($2,500 - $4,999)

	President's Circle ($5,000 And Above)

	Exact Amount:

Card Type:

Name On Card:

Card Number:

Expiration:

Dedication:	Please make this dedication in memory /honor of

Submit:

If you would like to make a recurring or monthly contribution please contact Paul Parks at 214-941-0523 or pparks@aidsdallas.org