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Hebrew School Tzedokah Raffle

Child's First Name*
Child's Last Name*
Grade*
Day of the week your child attends Hebrew School

SundayWednesday
E-mail*
Amount*

$ USD

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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