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Donation Details

Please fill out the form below if you would like to donate items or volunteer to help run a party this month!
Fields with an asterisk (*) are required.

First Name*:
Last Name*:


Address 1:
Address 2:

City:
State:
select
   Zip:  


Email* :

Phone*:


Shelter:
Elizabeth Stone House
Date/Time:
Monday, March 15, 2010
5:30 PM

Item:
Goody Bags

Will you deliver?


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