* required information
Assets Parents `Ohana
Dues & Donation Amount
Assets Parents `Ohana dues for the 2016-2017 school year is $50.00. If giving additional gift, add to dues and enter amount below.
:* $
Donor Information
Organization Name (if applicable):
Are there any instructions/comments that you would like to add?:
For recognition purposes, please type the donor name(s):
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:
Student Name:
Student Name:
Student Name:
Payment Information
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Credit Card Type:*
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
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State:
:
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Country:*
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