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Donations - Secure Online Donation Form

Campaign/Fund Information
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Donation Information
Donation Amount *
NOTE:
The minimum donation amount is $10.00
Payment Method *
Donation Type *


Number of Payments *  
Type of Donation *
Please indicate whether this donation is made on behalf of an individual or a corporation
If Corporate, provide legal name of corporation
For proper reporting to State Board of Elections
Do you wish to have your name published? *
Please indicate how you would like your name published in communications to NYSPA members
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Billing Phone *

Validation Code: Answer this simple math problem to validate your submission:

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